Can someone help me with the apt follow up regimen following reconstructive urethroplasty for stricture urethra? What defines Failure?
God has given three times larger diameter of urethra than required.
To define success clinically, symptoms and uroflowmetry is adequate. For research and publication urethrogram and cystoscopy is needed during follow up. As mentioned earlier surgical failures are usually seen within a year. Life long follow up is needed to define success.
I fully agree what jaideep and Pankaj as mentioned above.
The issue raised by Raju Ranjan on ‘Followup regime post
Urethroplasty’ has tickled the feathers and we have suitable replies from some
Jaideep Mahajani has informed us as to God’s wisdom in
providing the urethra with 3 times the luminal size than it actually requires.
This is true as in earlier years; it was considered that Urethral Luminal Size
was mentioned as Anatomical Size and Physiological Size. The latter was
considered as 1/3rd of the former. It was also then considered that
for symptoms due to Stricture to develop, the luminal size of urethra should
become 1/3rd of the physiological size. Though I used to teach these
in my previous years, the pundits of today do not give much relevance for this.
On many occasions, though a stricture may be present, it remains asymptomatic
and could be so over a long period of time. This is well accepted. This is true
as mentioned by Jaideep that even in Post Op Scenario, many patients will
remain asymptomatic even after the stricture has recurred.
The old adage ‘once a stricture, always a stricture’ is apt
even today. Most interventions are at best to give temporary solace for the
patient. Though we report success after Urethroplasty, many of these patients
are advised self calibration/self dilatation as part of continuing treatment.
Pankaj and Sanjay, I am sure will frown at this, I am sure. Any instrumentation
that is proposed after Urethroplasty, even the need for Urethroscopy after a
procedure should be considered as instrumentation. If after treatment, any form
of followup treatment has to be advised, then it is logical to presume that the
procedure has not yielded the result it was aimed for – Long life lasting Cure
from Stricture. Roy has aptly mentioned that ‘lifelong followup is needed to
The article provided by Prashant Mulawkar is worth a read
and understanding. He has mentioned that ‘Success and failure could be Anatomical
or Functional’. I am providing you the Algorithm mentioned in that article.
I am sure that this might rise a ‘hornet’s nest’ and there
could be many more discussions on this topic’
With warm Regards,