ROLE OF CLEAN INTERMITTENT SELF CATHETERISATION (CISC) IN THE PREVENTION OF RECURRENT URETHRAL STRICTURES AFTER INTERNAL OPTICAL URETHROTOMY
Abstract
Background: Urethral stricture is one of the oldest diseases Urethral dilatation Internal opticalurethrotomy,were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapideshas greatly decreased the recurrence of stricture. Objectives were to determine the role of CleanIntermittent Self Catheterisation (CISC) in the prevention of recurrence of urethral strictures afterInternal Optical Urethrotomy and to study the frequency of any postoperative complications andtolerability for the patients associated with this procedure. Methods: A randomised controlled studyconducted in the department of urology and renal transplantation, Institute of Kidney DiseasesHayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with meanage 48 years (range 20–73) were selected and randomly divided into Treatment Group (30 patients) andControl 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 usingSachse method followed by indwelling catheter for 5 days. The treatment group was then taught toperform 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 oneyear. All the patients were followed up regularly at 1 month intervals during the first 6 months and thenevery 2 months for the next 6 months. Results: Total of 48 patients completed the study, 22 in thetreatment group and 26 in the control group. Within the first year, 4 patients (22%) in the treatmentgroup developed urethral stricture. In the control group, 12 patients (46%) developed urethral stricturewithin the first year, showing a significant difference (p<0.01). In the treatment group four patientsdeveloped simple UTIs while in the control group three patients developed UTIs, one with concomitantepididymitis. No other complications were noted up to one year follow up. Conclusion: CleanIntermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence afterInternal Optical Urethrotomy and is associated with less morbidity and is cost effective. CISC is animportant modality for maintaining the normal urethral calibre.Keywords: Urethral Strictures, Optical Urethrotomy, Clean Intermittent Self Catheterisation,Recurrence, ComplicationsReferences
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