Urethral strictures
Because of the unsatisfactory long term results with minimal invasive treatment of urethral stricture by means of an urethrotomian slit (Urethrotomia interna) according to Sachse, efforts have been made over the past few years to find alternative therapies.
A good alternative is the laser-urethrotomy with our diode laser LIFE.
The incision is carried out at 5-, 7 and 12 o'clock, following a technique introduced by Merckle. The operation is mainly carried out with regional anaesthesia, and at high anaesthetic risk, also with local anaesthesia. Subsequently a Ch20 silicone permanent catheter is inserted under infection prevention for 3 days. After removing the catheter, urethral instillations (Farcotril ®) are given for a further 5 days in the outpatient department. After 6 weeks an evaluation is carried out by means of uroflowmetry, a retrograde urethrogram, an urethral sonography and if necessary urethroscopy.
In cases of residual or recurrent stricture and evidence of persistent scarring another laser session will be carried out.
Short strictures in the bulbar area respond particularly well to the treatment, those in the penile area a little less. In cases of recurrent urethral stricture the laser-urethrotomy leads to better long term results compared with the internal urethrotomy. With this treatment the recurrence rate is also relatively high with about 30%. Unlike the internal urethrotomy however, multiple laser sessions would not lead to a hopeless situation with increase of scarring and continuous deterioration of results. In contrast a steady reduction of the scarring can be observed, which means that even in cases of multiple recurrences and extensive scar tissue, good and stable long term results can ultimately be achieved with the LIFE laser technique.
