The blessings and curses of Urethrotomy

Today's urologist will very likely consider performing a Direct Visual Internal Urethrotomy (DVIU) very-early on in the progression of your case. Urethrotomy was once thought to be curative in a high percentage of patients, in-fact, as recently as the 1990's it was considered by many urologists as the primary "go-to" after the initial few dilitations with recurrence. There have been no formal studies addressing the recurrence rate of strictures after undergoing DVIU, however, conjecture is that it is around 90%, which leads to the question of cost-effectiveness for the insurer.  **see report on the University of Washington - Seattle, Department of Urology study regarding this hypothesis  HERE.

Medical schools with urology programs in Pennsylvania and New York are now instructing their progeny to perform a urethrotomy at first diagnosis of stricture for two primary reasons:

• First, it is thought to cause less scarring of the urethral wall, allowing for a more patent urethra with which to perform a future urethroplasty.
• Secondly, it is theorized that the stress of undergoing multiple dilitation routines may cloud the judgment of the novice stricture patient (who is most often in his late teens to mid-twenties). Performing a urethrotomy as the first surgical fix is thought to provide time for the patient to emotionally prepare for the eventuality which is urethroplasty, the "gold standard" of urethral repair options.

On average, expect two or three years of relief from strictures after a successful urethrotomy. Many urologists are attempting the extension of this interval by prescribing a regimen of self catheterization (with a Foley catheter) at regular intervals. Personally, I'd bite the bullet (per se), and opt for the "mucho invasive" option of urethroplasty. Catheterization "ain't" exactly a walk in the park...

Per: Moderator Tim