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Lookup NU author(s): Dr Matthew Jackson,
Professor Christopher HardingORCiD,
Dr Trevor Dorkin
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BackgroundIntermittent 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.ObjectivesDetermine the clinical and cost-effectiveness of ISD for the management of urethral stricture disease in males.Search MethodsThe strategy developed for the Cochrane Incontinence Review Group as a whole (last searched May 7, 2014).Selection CriteriaRandomised trials where one arm was a programme of ISD for urethral stricture.Data Collection and AnalysisAt least two independent review authors carried out trial assessment, selection, and data abstraction.ResultsData 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.ConclusionsISD 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. 35:759-763, 2016. (c) 2015 Wiley Periodicals, Inc.
Author(s): Ivaz SL, Veeratterapillay R, Jackson MJ, Harding CK, Dorkin TJ, Andrich DE, Mundy AR
Publication type: Review
Publication status: Published
Journal: Neurourology and Urodynamics
Print publication date: 01/09/2016
Online publication date: 11/06/2016
Acceptance date: 18/05/2016
ISSN (print): 0733-2467
ISSN (electronic): 1520-6777