Urethral Dilatation Procedure

Pre-Procedure Preparation

The American Urological Association recommends obtaining preoperative urine cultures to guide antibiotic selection and treat any active urinary tract infections before proceeding with dilation 3
The American Urological Association suggests administering appropriate prophylactic antibiotics following AUA Best Practice Policy guidelines to reduce surgical site infections 3
Determining stricture length and location using retrograde urethrography (RUG), voiding cystourethrography (VCUG), or urethro-cystoscopy prior to non-urgent procedures is recommended to guide treatment planning 2, 4

For meatal or fossa navicularis strictures, simple dilation can be performed as first-line treatment for uncomplicated cases 1, 6
The procedure can be performed with or without guidewire placement, depending on stricture complexity and location 5, 6

A urethral catheter should be placed following dilation to divert urine from the intervention site and prevent urinary extravasation 3
The catheter can be removed within 24-72 hours after uncomplicated dilation, as there is no evidence that prolonged catheterization beyond 72 hours improves outcomes 1, 2, 4

Success rates range from 35-70% for short strictures (<2 cm), with highest success in bulbar strictures less than 1 cm 4, 5, 7
Success rates drop dramatically for strictures >2 cm, with very low success for strictures longer than 4 cm 4

For recurrent strictures after failed dilation, urethroplasty should be offered instead of repeated endoscopic management, as failure rates exceed 80% with repeat procedures 1, 6
For recurrent bulbar strictures <3 cm, drug-coated balloon dilation may be considered, showing 83.2% freedom from intervention at 1 year versus 21.7% with standard dilation alone 1, 6
In patients not candidates for urethroplasty, intermittent self-catheterization after dilation (performed for >4 months) can maintain temporary urethral patency and reduce recurrence rates 1, 4

Repeated dilations for penile urethral strictures should be avoided, as these have expected high recurrence rates and should proceed directly to urethroplasty 5, 8
Dilation should not be performed on strictures associated with hypospadias, lichen sclerosus, or prior failed endoscopic manipulation without considering urethroplasty 5, 6
Dilation and DVIU have equivalent outcomes and can be used interchangeably based on surgeon preference and available equipment 1, 2, 5