What is the place of internal urethrotomy in the treatment of urethral stricture disease?

As a treatment for male urethral stricture, internal urethrotomy (IU) has the advantages of ease, simplicity, speed and short convalesence. Various modifications of the single cold-knife incision in the 12 o clock position have been proposed, but there are no prospective, randomized studies to prove their claims of greater efficacy. lU can be performed as an outpatient procedure using local anesthesia, with an indwelling silicone catheter for 3 days after the procedure. Complications of IU are usually minor, including infection and hemorrhage. The reported success rate of IU varies, mainly because of differences in the definition of success and the duration of follow-up. Strictures can recur, uaually within 3-12 months of IU. There are several known risk factors for recurrrance: a previous IU, penile and membranous strictures, long (>2 cm) and multiple strictures, untreated, perioperative urinary infection and extensive periurethral spongiofibrosis. Repeated IU followed by long-term self-dilation is an alternative option for men with severe comorbidity and limited life expectensy, or those who have failed previous urethroplasty. Overall, IU has a lower success rate (+/- 60%) than (+/- 80-90%), but if used for selected strictures, the success rateof IU could approach that of urethroplasty.