Dr Sanjay Balwant Kulkarni
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15 Jan 2023 10:47:27 AMDIVI followed by Self Dilation
Dear Friends
Self Dilation/self cath indications: Patient refuses urethroplasty, Patient unfit for surgery, after multiple failed urethroplasties.
Urethra is as sensitive as conjunctiva. Even after simple Xylocaine jelly insertion into the urethra we can see ecchymosis in the urethra.
If I prescribe 100 patients to perform self cath after DVIU, It indicates that the success rate of DVIU only is 0% in my mind.If the success rate of DVIU is 50% in my mind then I am asking 50% patients unnecessary self cath.
Clean intermittent self catheterization was was introduced by Lapides in 1972,where the patient has no or reduced urethral sensation.
We applied it stricture patients when urethroplasty results were not excellent like today.
Sanjay Kulkarni and Pankaj Joshi
Comments(5)
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Dr. Anil Takvani
22 May 2021 06:53:44 PMIn my experience of 21 years of practice at single center with high numbers of structure urethra I would like to share my experience:
Most common stricture etiology is post turp/ post instrumentationSecond common cause...post catheterizationThird ediopathic (unknown etiology)Fourth post Urethral infectionsFifth post accidental uretrhal trauma.In cases of post tur proximal bulbar stricture DVIU works well as most of the time they are not suitable for or not willing for urethroplasty.They do require catheter dilation at interval of 3 to 6 weeks to achieve long term results. They are the patients benefited by DVIU.In rest of the cases if stricture confined to only bulbar urethra and patient is very young I do attempt DVIU, leaving accidental uretrhal trauma.I request other members to share their work on this and another interesting post on similar topic by our legendary reconstructive urologists.Thanks Dr. Sanjay Kulkarni Sir to share you experiences, expertise and published work... -
Lalit Shah
12 Jun 2021 07:09:05 PMSelf calibration after DVIU is definitely not curative.
Have see many strictures becoming tighter and longer after self calibration.Most people use catheter for self calibration, the eye of catheter catches the healthy urethra while withdrawing and rested trauma and stricture enhancement,including new stricture at different part of urethra. -
Lalit Shah
12 Jun 2021 07:09:08 PMSelf calibration after DVIU is definitely not curative.
Have see many strictures becoming tighter and longer after self calibration.Most people use catheter for self calibration, the eye of catheter catches the healthy urethra while withdrawing and rested trauma and stricture enhancement,including new stricture at different part of urethra. -
Lalit Shah
12 Jun 2021 07:09:10 PMSelf calibration after DVIU is definitely not curative.
Have see many strictures becoming tighter and longer after self calibration.Most people use catheter for self calibration, the eye of catheter catches the healthy urethra while withdrawing and rested trauma and stricture enhancement,including new stricture at different part of urethra.
Venugopal P
22 May 2021 10:46:59 AMDear All,
I fully concur with the views of Sanjay and Pankaj and have mentioned the reasons for my apathy towards DVIU in a previous writeup.
There is much literature over years addressing the merits and demerits of DVIU. Self-calibration and Hydrostatic Dilatation are considered post DIVU as essential. As Sanjay has mentioned in one of his writeups, any procedure post Procedure means failure of the procedure. At best Uroflowmetry along with patient’s satisfaction are most important postop assessments. Hydrostatic Dilation was once popular after DVIU, but later studies showed that it could cause Intravasation and resulting in Enhanced Fibrosis and Resulting recurrence of the stricture which were more often of a longer length.
I reiterate excepting in exceptional circumstances, which have been mentioned in previous writeups on this issue, DVIU should be relegated to history.
With warm Regards,
Venu