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Urethrotomie

URETHROTOMIE

Urethral slitting (urethrotomia interna) is performed endoscopically and is the most commonly used procedure for urethral strictures.1In this method, an incision is made in the stricture with the aim of achieving a larger lumen of the urethra..

After this procedure, scarring occurs at the edges of the incision. In addition, part of the healthy tissue is always injured, which extends the length of a recurrence gene with each procedure. According to various studies, recurrence rates range from 60% to 100%.2,3,4 Depending on the number of previous surgeries and the length of the stricture, the probability of success of this procedure varies. Santucci u. Eisenberg (2010)5 analyzed data from 76 patients who underwent urethrotomy. Unfortunately, in 8% of cases, no recurrent stenosis occurred after initial slitting.

On average, recurrence occurred seven months postintervention. Furthermore, the authors demonstrate the very low efficacy of multiple urethrotomies. After the second procedure, recurrence of stricture occurred in 94% of cases and after more than three procedures in 100% of patients. This means that continuous and lifelong treatment of recurrences can be assumed in almost all patients. Furthermore, multiple urethrotomies decrease the chances of long-term cure of the condition with the help of other treatments.6,7 The most favorable prognosis is for short strictures less than 1.5 cm in length that are slit for the first time.8

Thus, although endoscopic slitting is one of the simplest procedures, it is also one of those associated with the most frequent recurrences. Therefore, permanent elimination of the stricture cannot be achieved by urethrotomies in most cases, but only by reconstructive surgery.9,10

1 Klevecka et al. Harnröhrenstriktur: Ursachen, Klassifikation, Diagnostik und Behandlung. Journal für Urologie und Urogynäkologie. 2010; 17(4):16-24.
2 Steenkamp et al. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol 1997; 157: 98–101.
3 Pansadoro , Emiliozzi . Internal urethrotomy in the management of anterior urethral strictures: long-term follow up. J Urol 1996; 156: 73–5.
4 Leyh. Urethrotomia interna. Urol 2015; 46: 382–387
5 Santucci, E. u. Eisenberg, L. (2010): Urethrotomy Has a Much Lower Success Rate Than Previously Reported. THE JOURNAL OF UROLOGY®. Vol. 183, 1859-1862, May 2010
6 Kessler et al. Long-term results of surgery for urethral stricture: a statistical analysis. J Urol. 2003 Sep;170(3):840-4.
7 Santucci, E. u. Eisenberg, L. (2010): Urethrotomy Has a Much Lower Success Rate Than Previously Reported. THE JOURNAL OF UROLOGY®. Vol. 183, 1859-1862, May 2010
8 Pansadoro , Emiliozzi P. Internal urethrotomy in the management of anterior urethral strictures: long-term follow up. J Urol 1996; 156: 73–5.
9 Zugor et al. Offene urethrale Rekonstruktion bei Harnröhrenstrikturen. Urologie. 2014(1): 76-78
10 Santucci and Eisenberg. Urethrotomy has a much lower success rate than previously reported. The Journal of urology. 2010; 185(5):1859-1862.