ROLE OF CLEAN INTERMITTENT SELF CATHETERISATION (CISC) IN THE PREVENTION OF RECURRENT URETHRAL STRICTURES AFTER INTERNAL OPTICAL URETHROTOMY

Sarhad khan, Riaz Ahmad Khan, Anayat Ullah, Faheem ul Haq, Ata ur Rahman, Sadia Nawaz Durrani, Muhammad Kamran Khan

Abstract


Background: Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical
urethrotomy,were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapides
has greatly decreased the recurrence of stricture. Objectives were to determine the role of Clean
Intermittent Self Catheterisation (CISC) in the prevention of recurrence of urethral strictures after
Internal Optical Urethrotomy and to study the frequency of any postoperative complications and
tolerability for the patients associated with this procedure. Methods: A randomised controlled study
conducted in the department of urology and renal transplantation, Institute of Kidney Diseases
Hayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with mean
age 48 years (range 20–73) were selected and randomly divided into Treatment Group (30 patients) and
Control Group (30 Patients). Eight “drop out” occurred in the treatment group and four “drop out”
occurred in the controlled group. All the patients were treated with Internal Optical Urethrotomy using
Sachse method followed by indwelling catheter for 5 days. The treatment group was then taught to
perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter (No. 16 or 18)
twice a day for 1 week, then once a day for another 4 weeks and then once weekly continued for one
year. All the patients were followed up regularly at 1 month intervals during the first 6 months and then
every 2 months for the next 6 months. Results: Total of 48 patients completed the study, 22 in the
treatment group and 26 in the control group. Within the first year, 4 patients (22%) in the treatment
group developed urethral stricture. In the control group, 12 patients (46%) developed urethral stricture
within the first year, showing a significant difference (p<0.01). In the treatment group four patients
developed simple UTIs while in the control group three patients developed UTIs, one with concomitant
epididymitis. No other complications were noted up to one year follow up. Conclusion: Clean
Intermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence after
Internal Optical Urethrotomy and is associated with less morbidity and is cost effective. CISC is an
important modality for maintaining the normal urethral calibre.
Keywords: Urethral Strictures, Optical Urethrotomy, Clean Intermittent Self Catheterisation,
Recurrence, Complications

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