Can Urethral Stricture be Treated Under Local Anesthesia?

Abstract

Objectives : to evaluate the ability to treat mid urethral stricture under local anesthesia.

Material and Methods

A total of 15 patient aged 19 to 72 years old with lower urinary tract symptoms (LUTS) mainly poor stream and incomplete emptying , High post void residual urine on Ultra sound (Mindray DC30 hospital type) and low Q max (uroflow metery) , diagnosed as urethral stricture by urethrogram less than 1.5 cm were included in this study. Starting by insert 10-15 ml of lidocaine gel 5% in side urethra and waiting for 20 minutes then Checking cystoscopy done by C Mack karl stroz to diagnosis the urethral stricture and identifying urethral stricture then to passed hyderophilic guide wire ( indovasive nano glide straight tip size 0.032) to bladder and confirm its position in bladder with Ultra sound (Mindray DC30 hospital type) then gradually dilated the urethra with flexible dilators ( indovasive from 6 fr to 24 fr ) then rescope the patient to ensure potency of urethra with C Mack and finally inserted foley catheter 16 -18 fr keep it for 10 -14 days, and follow up patient with International Prostate Symptoms Score, PVR assessment by Us and Q max by flowmetery.

The study was approved by the ethical committee of the Iraqia Med school ….
Written informed consent was obtained from all patients participating in the study. Patients were provided with a direct phone number to call in case of any bothersome adverse effects during the post operative period after dilation.

Data were entered and analyzed using SPSS version 25.

The IPSS symptoms score, PVR values and Q max were compared the study group before and after dilation Student paired-samples t-test using Numbers version 10.1 for MacBook pro2020.

Results

 There were  significantly decrease in overall PVR before and after ( mean PVR before dilation 218.6 ± cc ….and after dilation 12.8±cc…. p < 0,000000000027 ) and IPPSS before and after (mean IPSS before 20.5± cc …. IPSS after 9.33±cc… p < 0,000000000000031) . And significantly increase in Q max before and after ( mean Q max before 7.43±cc … after 20.2±cc…..p< 0,0000000000055) . All patient tolerate the dilation with no complication apart from little discomfort from foley which vanished with time.

Conclusion  Mild urethral stricture can be treated under local anesthesia successfully with frequent dilation can avoid patient GA or Spinal anesthesia