Many urologists advice patients with urethral stricture disease to carry out clean intermittent self-catheterisation when the patient is unable or unwilling to have surgical treatment. If this is your practice, how often do you advise patients to self-catheterise?
Frequently enough to ensure that bladder pressure remains acceptable ... The underlying urinary system pathology has also to be taken into account (e.g. neurogenic bladder, benigh prostatic hyperplasia).
Yes, I agree with Panagiota Diamantopoulou Reiter. I'm retired now (from my role as a nurse practitioner), but used to be involved with intermittent self catheterisation.
I would have wanted to gain an understanding of how adequately the patient's bladder emptying was (with the aid of post void portable ultrasound), what Charrière (Ch.) catheter could be passed and whether the patient had difficulty in voiding without the use of an in-out catheter. If voiding was difficult, then the use of a catheter would need to be more frequent, to keep the residual urine down. If an intermittent catheter was used to dilate the stricture, then I would have advised use on a twice daily basis, increasing the Ch. to - perhaps - 18Ch. on a gradual basis. Usually the referring urologist would recommend the Ch. to aim at.
I used to feel that this was a sound plan of care in itself without it being reserved for those who could not or would not have surgery, and was asked, by urologists to be involved with stricture therapy.
Very best wishes,
Mary
The CISC has only a beneficial role in reducing stricture recurrenc postoperatively, in patients primarily treated by internal urethrotomy, However, it is recommended for management of selected patients of recurrent urethral strictures.
Catheterization should be frequent enough to prevent bladder overdistension. Therefore, patients should normally catheterize at least four times/ day, with increasing frequency in children and those with a small capacity bladder, which can be suggested by the volume obtained on catheterization.
Patients will learn to balance fluid intake with frequency of characterization in order to maintain acceptable bladder pressure and remain dry. Unless the patient catheterizes during the night, no bedtime drink is allowed, u
Perhaps, I did not make myself clear. My question was addressed to identify the frequency of self-catheterisation necessary to prevent a stricture developing again, hence avoiding the need to bring an unwilling/unfit patient back for another internal urethrotomy. It does not apply to patients with neurogenic bladders, hypotonic detrusors or those with DSD or BPH, who would need self-catheterisation several times a day.
I ask them to do once a day.
Remember, depending on the location of their stricture, they only need to get the catheter past the stricture. Thus for a fossa naviculars urethral stricture, they don't need to push in very far.
Some disease conditions, such as a history of radiation therapy for prostate cancer, may really create a dense stricture, and the patients may need to try several different catheters until they end up with one that 'works'.
Yes, I agree; sometimes those with meatal strictures can use a short hydrophilic catheter available with no eyelets, that just goes past the stricture.
Thanks Dr. Batura for clarification and sorry for misunderstanding.
I agree with Dr. Master and Dr. Wilson. To avoid the need to bring an unwilling/unfit patient back for another internal urethrotomy, it may be enough to pass the stricture site once a day.
I suggest my patient self urethral dilatation by hydrophilic catheter after internal urethrotomy as monthly.
I ask them to do it every week for first three months and then monthly for a long time. In some patients, I will ask them to do catheterization when they feel that the stream has slowed down.
Throughout my career I recommended daily for one week after initial dilation, then every other day and then at first indication of a slowing stream. This also worked on female to male penile reconstruction referred to me for strictures.
My personal experience with a mid urethral stricture -following a TURBT with a 28fr resectoscope - was to use a 15 to 18 cm segment of catheter (with a safety pin to prevent intraurethral loss). I catheterized as above. Now, 8 years later I continue to have a normal stream and uroflow.
Regarding urethralgia, the probably has a sub-clinical pudendal neuropathy - that nerve innervates urethral sensation. Urethralgia in both genders needs evaluation for pudendal neuropathy.
I ask them to do it once daily for 2 weeks. then every other day for 2 weeks, followed twice per week for 2 weeks, then once per week for one month, then twice per month for 2 month, then to be continued once per month, as long as he can.
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