Optic internal urethrotomy under transrectal ultrasonographic guide and suprapubic fiberoscopic aid

Optic internal urethrotomy is the initial treatment of choice for most urethral strictures because of the relatively low morbidity and ease of accomplishment. However, the procedure is difficult and frustrating if a severe stricture or complete disruption of the urethra is encountered. Transrectal ultrasonography of the urethra offers good anatomical visualization, and defines the exact length and extent of bulbous and posterior urethral strictures, which could ensure a more accurate and aggressive incision of the stricture. Eleven patients (8 with posttraumatic and 3 with iatrogenic strictures) with complete obliteration of the bulbous and posterior urethra were successfully treated by optic internal urethrotomy with the aid of transrectal ultrasonography and a suprapubic fiberscope. After 1 year of followup, 5 of the 8 posttraumatic urethral strictures required further management, while the remaining patients had satisfactory results. Although the recurrence rate is high in the posttraumatic patients, transrectal ultrasound and the suprapubic fiberoscope afford a reliable and satisfactory aid during optic internal urethrotomy.