Operative technique
stricture
PRESSURE AREA, STRICTURE, BLADDER, COLD, URETHRA
The procedure was carried out by one surgeon under spinal anesthesia in lithotomy position with padding of pressure areas. Perioperative antibiotics were given to all patients. Initial urethrocystoscopy was done using (16 fr) diagnostic cystoscope (Karl Storz, Germany) under video monitoring with placement of (5 fr) ureteral catheter to measure the stricture length and a (0.035 mm) guide wire fixed into the urinary bladder. In group A, the urethrotome was advanced in the urethra through (22 fr) cystoscopy sheath up to the stricture site. The incision was done using the cold knife at 12 o’clock position. The procedure was repeated till the stricture appeared to be opened up. Once the stricture was ablated, the diagnostic cystoscopy was passed into the urinary bladder. Bladder was emptied and safety wire may be removed. In group B, the machine used was Ho:YAG laser device (Sphinx 100 W, holmium-YAG laser, LISA Laser Products–OHG, Germany) with setting of 15 W power (2 J and 15 Hz frequency). The holmium laser fiber 550 µm was introduced through the (22 fr) cystoscopy sheath. Incision was done with the laser fiber at 12 o’clock. Once the stricture was ablated, the diagnostic cystoscopy was passed into the urinary bladder. Bladder was emptied and safety wire may be removed. In all patients of both groups, Foley’s catheter (16 fr) was inserted per urethra for approximately 5 days. Operative time was calculated from the beginning of insertion of cystoscopy sheath from external urethral meatus involving the treatment of stricture site to the removal of working endoscopy from urethral meatus and catheter fixation.