SELF-RETAINING F O L L O W E R FOR URETHRAL STRICTURES ANTHONY ATALA, M.D. GREG S. STEINBOCK, M.D. From the Division of Urology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky Filiform and followers are commonly used for dilation of urethral strictures. Insertion of a urethral Foley catheter is often necessary after dilation of the stricture. Gaining access to the bladder that has tight or multiple strictures is difficult. Under these circumstances, if a fillform and follower are removed in order to insert the Foley catheter, bladder access can be lost. One way to overcome this problem is to use the Council catheter, which is threaded over a long filiform. However, with tight and multiple strictures, the soft Council catheter may not go through the area. An alternative method is the Council catheter guide, which is a flexible steel catheter guide with a threaded male end that attaches to the female end of the filiform. However, this rigid catheter guide may be difficult to pass and may be dangerous, resulting in further false passages and urethral perforation. Another technique used to avoid losing bladder access is to secure the filiform and Phillips follower with tape or umbilical ties, allowing the follower to soften and dilate the stricture as well as provide bladder drainage. After twentyfour to forty-eight hours, the filiform and follower can then be replaced easily with a Foley catheter, although several problems arise with this technique. Patients can inadvertently pull the filiform and follower, and bladder access is again lost. Also, tape and umbilical ties can cause tape burns and edema at the genital area.

FIGURE 2. Urethral ]ili]orm curled in bladder at~ tached to sell-retaining ]ollower with balloon in flated allows for urine drainage without risk of los ing urethral access. A new follower has been developed with balloon at the bladder end that allows for sell retention of the filiform and follower* (Fig. 1) Once the filiform and Phillips follower hav~ been used for bladder access and dilation of th! stricture, the self-retaining follower with th~ deflated balloon i; threaded to the filiform, ad! a d, a d u ed in the bladder by inflatinl the balloon with 3 to 5 m L of water (Fig. 2)i This system allows bladder drainage, furthd softening, and dilation of the urethral stricturii Twenty-four to forty-eight hours later, one c.'! deflate the balloon, remove the filiform an~ s e l ~ e t a i ~ n g follower, and replace them withi Fo y ca eter "f eded. More than 15 patien i with difficult urethral strictures have bee! managed successfully using this technique. 550 South Jackson

FICURE 1. Urethral follower (top). New sell-retaining urethral ]oUower (bottom) with port ]or drainage bag and valve for balloon inflation. 66

(DR. *Cook Urological, 10O West Morgan Street, P.O. Box Spencer, Indiana.

UROLOGY

/ JULY 1991

/

VOLUME XXXVIII,

Self-retaining follower for urethral strictures.

SELF-RETAINING F O L L O W E R FOR URETHRAL STRICTURES ANTHONY ATALA, M.D. GREG S. STEINBOCK, M.D. From the Division of Urology, Department of Surgery...
95KB Sizes 0 Downloads 0 Views