title: Internal urethrotomy combined with antegrade flexible cystoscopy for management of obliterative urethral stricture.
abstract: BACKGROUND
  We studied the safety and efficacy of flexible cystoscopy-guided internal urethrotomy in the management of obliterative urethral strictures.
  
  
  METHODS
  Forty-three flexible cystoscopy-guided internal urethrotomies were performed between 1999 and 2005. The indication for the procedure was nearly blinded bulbar or membranous urethral strictures not longer than 1 cm that would not allow passage of guide wire. Candidates were those who refused or were unable to undergo urtheroplasty. By monitoring any impression of the urethrotome on the monitor through the flexible cystoscope, we were able to do under-vision urethrotomy. All of the patients were started clean intermittent catheterization afterwards which was tapered over the following 6 months. Follow-up continued for 24 months after the last internal urethrotomy.
  
  
  RESULTS
  Seventeen patients were younger than 65 years with a history of failed posterior urethroplasty, and 26 were older than 65 with poor cardiopulmonary conditions who had bulbar urethral stricture following straddle or iatrogenic injuries. Urethral stricture stabilized in 16 patients (37.2%) with a single session of urethrotomy and in 17 (39.5%) with 2 urethrotomies. Overall, urethral stricture stabilized in 76.7% of patients with 1 or 2 internal urethrotomies within 24 months of follow-up. No severe complication was reported.
  
  
  CONCLUSIONS
  Flexible cystoscopy-guided internal urethrotomy is a simple, safe, and under-vision procedure in obliterative urethral strictures shorter than 1 cm. It can be an ideal option for patients who do not accept posterior urethroplasty or are in a poor cardiopulmonary condition that precludes general anesthesia.
authors.affiliation: Department of Urology, Shohada-e-Tajrish Hospital and Reproductive Health Research Center, Shahid Beheshti University (MC), Tehran , Iran. jhosseinee@gmail.com
authors.forename: Seyed Jali
authors.initials: SJ
authors.lastname: Hosseini
authors.forename: Ali
authors.initials: A
authors.lastname: Kaviani
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Vazirnia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D020684:Cystoscopes; D003558:Cystoscopy; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014546:Urinary Catheterization; D014563:Urodynamics; D055815:Young Adult