The use of Amplatz renal dilators in the minimally invasive management of complex urethral strictures

Introduction To present the outcomes of using Amplatz renal dilators in the management of complex urethral strictures. Material and methods From September 2011 to August 2015, 34 patients with complex urethral strictures were treated with Amplatz renal dilators assisted with internal urethrotomy. Evaluation included uroflowmetry, IPSS and post-void residual volume measurement. Under spinal anesthesia, sequential dilatations were performed with Amplatz renal dilators measuring from 8 Fr up to 24 Fr. Urethrotomy was sequentially performed. Results The mean stricture length was 2.6 (1.5-3.5) cm. Preoperative mean Qmax was 4.4( 3.2-9.6) ml/sec. From September 2011 to August 2015, 34 patients with complex urethral strictures were treated with Amplatz renal dilators assisted with internal urethrotomy. Evaluation included uroflowmetry, IPSS and post- void residual volume measurement. Under spinal anesthesia, sequential dilatations with Amplatz renal dilators over an 8 Fr stylet were performed up to 24 Fr. Urethrotomy was sequentially performed. PVR was 155 (75-380) ml. Postoperative mean Qmax at 1 month was 18.4 (14.6-21.8) ml/sec, p <0.001, at 6 months was 16.6 (9.8-18.2) ml/sec, p <0.003 and at 12 months was 12.7 (7.4-17.3) ml/sec, p <0.005. Accordingly, mean PVR was significantly improved postoperatively, at 32 (12-88) ml in 1 month, p <0.001, while at 6 months was 34 (28-101) ml, p <0.005 and at 12 months was 62 (38-115) ml, p <0.005. Only 8 patients (23.5%) had a stricture recurrence in the first nine months and were treated with Amplatz dilatations alone. Conclusions The use of Amplatz renal dilators in combination with internal urethrotomy is a safe and effective technique for the endoscopic treatment of complex urethral strictures in patients unfit for reconstructive surgery.