Intermittent self-dilatation for urethral stricture disease in males: A systematic review and meta-analysis.

ABSTRACT

BACKGROUND: Intermittent self-dilatation (ISD) may be recommended to reduce the risk of recurrent urethral stricture. Level one evidence to support the use of this intervention is lacking. OBJECTIVES: Determine the clinical and cost-effectiveness of ISD for the management of urethral stricture disease in males. SEARCH METHODS: The strategy developed for the Cochrane Incontinence Review Group as a whole (last searched May 7, 2014). SELECTION CRITERIA Randomised trials where one arm was a programme of ISD for urethral stricture. DATA COLLECTION AND ANALYSIS: At least two independent review authors carried out trial assessment, selection, and data abstraction. RESULTS: Data from six trials that were pooled and collectively rated very low quality per the GRADE approach, indicated that recurrent urethral stricture was less likely in men who performed ISD than those who did not (RR 0.70, 95% CI 0.48-1.00). Two trials compared programmes of ISD but the data were not combined and neither were sufficiently robust to draw firm conclusions. Three trials compared devices for performing ISD, results from one of which were too uncertain to determine the effects of a low friction hydrophilic catheter versus a polyvinyl chloride catheter on risk of recurrent urethral stricture (RR 0.32, 95% CI 0.07 to 1.40); another did not find evidence of a difference between 1% triamcinolone gel for lubricating the ISD catheter versus water-based gel on risk of recurrent urethral stricture (RR 0.68, 95% CI 0.35 to 1.32). No trials gave cost-effectiveness or validated PRO data. CONCLUSIONS: ISD may decrease the risk of recurrent urethral stricture. A well-designed RCT is required to determine whether that benefit alone is sufficient to make this intervention worthwhile and in whom. Neurourol. Urodynam. 35759-763, 2016. © 2015 Wiley Periodicals, Inc.