title: Intermittent self-dilatation for urethral stricture disease in males: A systematic review and meta-analysis.
abstract: Intermittent self-dilatation (ISD) may be recommended to reduce the risk of recurrent urethral stricture. Level one evidence to support the use of this intervention is lacking.
  
  
  
  Determine the clinical and cost-effectiveness of ISD for the management of urethral stricture disease in males.
  
  
  
  The strategy developed for the Cochrane Incontinence Review Group as a whole (last searched May 7, 2014).
  
  
  
  Randomised trials where one arm was a programme of ISD for urethral stricture.
  
  
  
  At least two independent review authors carried out trial assessment, selection, and data abstraction.
  
  
  
  Data from six trials that were pooled and collectively rated very low quality per the GRADE approach, indicated that recurrent urethral stricture was less likely in men who performed ISD than those who did not (RR 0.70, 95% CI 0.48-1.00). Two trials compared programmes of ISD but the data were not combined and neither were sufficiently robust to draw firm conclusions. Three trials compared devices for performing ISD, results from one of which were too uncertain to determine the effects of a low friction hydrophilic catheter versus a polyvinyl chloride catheter on risk of recurrent urethral stricture (RR 0.32, 95% CI 0.07 to 1.40); another did not find evidence of a difference between 1% triamcinolone gel for lubricating the ISD catheter versus water-based gel on risk of recurrent urethral stricture (RR 0.68, 95% CI 0.35 to 1.32). No trials gave cost-effectiveness or validated PRO data.
  
  
  
  ISD may decrease the risk of recurrent urethral stricture. A well-designed RCT is required to determine whether that benefit alone is sufficient to make this intervention worthwhile and in whom. Neurourol. Urodynam. 35:759-763, 2016. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Institute of Urology, University College London Hospital, London, United Kingdom.
authors.forename: Stella L
authors.initials: SL
authors.lastname: Ivaz
authors.affiliation: Department of Urology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: Rajan
authors.initials: R
authors.lastname: Veeratterapillay
authors.affiliation: Institute of Cellular Medicine, The Medical School, Newcastle University, United Kingdom.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Jackson
authors.affiliation: Department of Urology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Harding
authors.affiliation: Department of Urology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Dorkin
authors.affiliation: Institute of Urology, University College London Hospital, London, United Kingdom.
authors.forename: Daniela E
authors.initials: DE
authors.lastname: Andrich
authors.affiliation: Institute of Urology, University College London Hospital, London, United Kingdom.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Mundy
mesh_terms: D004106:Dilatation; D019468:Disease Management; D006801:Humans; D008297:Male; D011788:Quality of Life; D000073278:Self-Management / Q000379:methods*; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000628:therapy*; D062885:Urinary Catheters
keywords: intermittent self-dilatation; meta-analysis; quality of life; systematic review; urethra; urethral dilatation; urethral stricture; urethroplasty; urethrotomy