Value of preoperative urethral ultrasound in optic internal urethrotomy.
OBJECTIVE
The recurrence rate of internal urethrotomy (IU) is still high (long-term curative success rate between 20 and 45% after the first IU). We aimed to establish in a prospective randomized trial the value of urethral ultrasound in inflammatory urethral stricture (IUS) diagnosis and treatment.


METHODS
Between June 1994 and January 2004, we performed IU in 562 cases with IUS (under 1.5 cm). In order to evaluate the results obtained by guided incision according to the echographic evaluation, patients have been divided into 2 groups. For the first group (319 cases), the IU technique has been adapted to the echographic aspect of the stricture zone, and to the fibrosis location on the urethral circumference. For patients of the second group (243 cases) we practiced IU with a "classical" 12 o'clock incision. The mean follow-up period was 38.7 months (range 4-71 months) and 37.9 months (range 5-69 months) for the second group. We used the SPSS 8.0 for Windows statistical analysis (Cox regression) with Kaplan-Meier curves in order to compare the recurrence-free survival time.


RESULTS
In the first group (44.5% recurrence rate) we found 4 specific locations of urethral stricture fibrosis according to ultrasound evaluation: dorsal urethral fibrosis (274), ventral urethral fibrosis (36), circular urethral fibrosis (136), dorsal and ventral fibrosis (114). The best results have been obtained for the dorsal and ventral location of the spongious fibrosis (45/153 recurrences, 29.4% and 9/22 recurrences, 41%). The recurrence rate was higher in the circular and concomitant dorsal and ventral location of the spongious fibrosis: 67.5% (52/77 cases) and 55.2% (37/67 cases). Cox regression (-2LL=360.859, chi2=47.670, Sig=0.137) demonstrated statistical significance in these series (p<0.5). In the second group (51.5% recurrence rate) we found 64.2% recurrences for the ventral location, 83% for the circular location and 72.3% for the dorsal and ventral location of the spongious fibrosis.


CONCLUSIONS
According to our experience, the high recurrence rate of IUS after IU may be explained by the inadequate type of incision. So, urethral ultrasound could improve the IU technique by better location of the fibrosis area.
Geavlete
Petrişor
P
Department of Urology, Saint John Emergency Clinical Hospital, Sos. Vitan-Barzesti 13, 75669 Bucharest, Romania. geavlete@net4u.ro
Cauni
Victor
V
Georgescu
Dragoş
D
D018572:Disease-Free Survival; D019160:Endosonography / Q000379:methods*; D005336:Fiber Optic Technology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012007:Rectum; D015203:Reproducibility of Results; D055502:Secondary Prevention; D016896:Treatment Outcome; D018666:Ureteroscopy; D014525:Urethral Stricture / Q000000981:diagnostic imaging* / Q000601:surgery