Personal perspective on the role of urethroscopy in the diagnosis and treatment strategy selection for short strictures of the bulbar urethra

Introduction. The importance of urethroscopy in the diagnosis of urethral stricture has been underestimated recently due to the priority in favor of urethrography. However, this method allows us to identify various aspects of urethral stricture, which can significantly affect the choice of the extent of surgical intervention.

Objective. To evaluate the diagnostic capabilities of urethroscopy and the outcomes of treatment strategies selected based on its findings in patients with urethral stricture.

Materials & methods. The study included seven men with short stricture (less than 20 mm) of the bulbous urethra, who were treated by removing fibrinous tissues of the urethra during urethroscopy. The age of the patients ranged from 19 to 73 years with a mean value of 44.6 ± 19.4 years. The length of the stricture according to retrograde urethrography ranged from 0.5 to 1.5 cm with a mean value of 1.0 ± 0.3 cm. In 4 patients (57.1%), the urethral stricture was primary, in 3 (42.9%) it was recurrent. Cystostomy drainage was present in four patients (57.1%). Ureteroscopy was performed using a standard technique using a ureteroscope 9.5 Ch, during which the nature of the changes in the mucosa and the degree of narrowing of the urethral lumen were examined. Next, the possibility of easy (without applying strong pressure) separation of fibrin adhesions from the urethral wall using a ureteroscope was assessed. The instrument was then removed and a urethral silicone catheter 18 Ch was installed for 21 days.

Results. In all patients, fibrin membranes (n = 5) or cords (n = 2) were found in the bulbar urethra during urethroscopy, which almost completely blocked the lumen of the urethra in this area. At the same time, no annular (true) narrowing of the urethra was noted in this area, which is typical for spongiofibrosis or true damage to the urethral mucosa. Fibrin membranes and cords had a thin layer and a loose structure, which made it possible to pass an endourological guidewire through them. After this, with a smooth movement of the ureteroscope, it was easy to remove fibrin adhesions along the entire perimeter of the urethral wall in all patients, since they had a loose nature of connections with the urethral mucosa. In none of the observations was cold or laser dissection of fibrin fibers or the urethral wall itself performed in this area, and during removal of fibrin tissues with an endoscope, there was no rupture of the urethral mucosa. After release from fibrin adhesions, the urethral wall had good elasticity, which allowed free passage of a Foley 18 Ch catheter. The duration of the manipulation ranged from 5 to 10 minutes and averaged 7.6 ± 1.7 minutes. The follow-up periods after treatment of patients varied from 8 to 24 months with a mean value of 13.6 ± 5.3 months. No complications during or after the manipulation, as well as recurrence of urethral stricture during the entire observation period were noted in any patient.

Conclusions. Urethroscopy examination reveals many cases of urethral stricture that can be corrected without urethroplasty or internal urethrotomy. Therefore, it is advisable to use urethroscopy examination more actively in patients with urethral stricture.

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