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


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, Complications


Sachse H. [Treatment of urethral stricture: transurethral slit in

view using sharp section]. [Article in German]. Furtschr Med


Gaches CGC. Ashken MH, Dunn M, Hammonds JC, Jenkins IL,

Smith PJB. The role of selective internal urethrotomy in the

management of urethral stricture: a multi-centre evaluation. Br J

Urol 1979;51:579–83.

Hjortrup A, Walter S. Kristensen JK, Bilde T. Stricture of the

urethra treated by internal urethrotomy by Sachse’s method.

Ugeskr Laeger 1983:145:734–6.

Bakke A. Clean intermittent catheterisation-physical and

psychological complications. Scan J Urol Nephrol Suppl


Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent

self-catheterisation in the treatment of urinary tract disease. J Urol


Kjrergaard B, Walter S, Bartholin J, Andersen JT, Nøhr S, Beck

H, et al. Prevention of urethral stricture recurrence using clean

intermittent self-catheterisation. Br J Urol 1994;73:692–5.

Wyndaele JJ and Maes D. Clean intermittent self-catheterisation:

a 12-year follow-up J Urology 1990;143(5):906–8.

De Ridder DJ, Everaert K, Fernández LG, Valero JV, Durán AB,

Abrisqueta ML, Ventura MG, Sotillo AR. Intermittent

catheterisation with hydrophilic-coated catheters (SpeediCath)

reduces the risk of clinical urinary tract infection in spinal cord

injured patients: a prospective randomised parallel comparative

trial. Eur Urol 2005;48:991–5.

Khalid M, Sanaullah, Ahmad M, Husain S. Clean intermittent

self dilatation as an adjunct to optical urethrotomy for

rehabilitation of anterior urethral stricture. Pak Postgrad Med J


Lauritzen M, Greis G, Sandberg A, Wedren H, Ojdeby G,

Henningsohn L. Intermittent self-dilatation after internal

urethrotomy for primary urethral strictures: A case-control study.

Scand J Urol Nephrol 2009;43:220–5.

Mubasher H. Turi, Hanif S, Shaikh MA. Proportion of

complications in patients practicing clean intermittent selfcatheterisation (CISC) vs indwelling catheter. J Pak Med Assoc


Wyndaele JJ. Complications of intermittent catheterisation: their

prevention and treatment. J Spinal Cord 2002;40:536–41.




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