Intermittent self‐dilatation for urethral stricture disease in males

Background Intermittent urethral self‐dilatation is sometimes recommended to reduce the risk of recurrent urethral stricture. There is no consensus as to whether it is a clinically effective or cost‐effective intervention in the management of this disease. Objectives The purpose of this review is to evaluate the clinical effectiveness and cost‐effectiveness of intermittent self‐dilatation after urethral stricture surgery in males compared to no intervention. We also compared different programmes of, and devices for, intermittent self‐dilatation. . Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 7 May 2014), CENTRAL (2014, Issue 4), MEDLINE (1 January 1946 to Week 3April 2014), PREMEDLINE (covering 29 April 2014), EMBASE (1 January 1947 to Week 17 2014), CINAHL (31 December 1981 to 30 April 2014) OpenGrey (searched 6 May 2014), ClinicalTrials.gov (6 May 2014), WHO International Clinical Trials Registry Platform (6 May 2014), Current Controlled Trials (6 May 2014) and the reference lists of relevant articles. Selection criteria Randomised and quasi‐randomised trials where one arm was a programme of intermittent self‐dilatation for urethral stricture were identified. Studies were excluded if they were not randomised or quasi‐randomised trials, or if they pertained to clean intermittent self‐catheterisation for bladder emptying. Data collection and analysis Two authors screened the records for relevance and methodological quality. Data extraction was performed according to predetermined criteria using data extraction forms. Analyses were carried out in Cochrane Review Manager (RevMan 5). The primary outcomes were patient‐reported symptoms and health‐related quality of life, and risk of recurrence; secondary outcomes were adverse events, acceptability of the intervention to patients and cost‐effectiveness. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Main results Eleven trials were selected for inclusion in the review, including a total of 776 men. They were generally small; all were of poor quality and all were deemed to have high risk of bias. Performing intermittent self‐dilatationversus not performing intermittent self‐dilatation The data from six trials were heterogeneous, imprecise and had a high risk of bias, but indicated that recurrent urethral stricture was less likely in men who performed intermittent self‐dilatation than men wh