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Biomedical subjects

C F Heyns

Publications and source records attributed to C F Heyns.

At least 19 recordsLinked to original sources
PubMed2006

Bicalutamide (Casodex) 150 mg plus standard care in early non-metastatic prostate cancer: results from Early Prostate Cancer Trial 24 at a median 7 years' follow-up.

Trial 24, one of three ongoing trials in the Early Prostate Cancer programme, is evaluating the efficacy and tolerability of bicalutamide (Casodex) 150 mg following standard care (radiotherapy, radical prostatectomy or watchful waiting) in patients with early, non-metastatic prostate cancer. At 7 years' median follow-up, addition of bicalutamide significantly improved objective progression-free survival (PFS) for patients with locally advanced disease, reducing the risk of progression by 34% versus standard care alone (hazard ratio 0.66; 95% confidence interval 0.55, 0.79; P<0.001). In localized disease, a significant difference in objective PFS was not found. There was no significant difference in overall survival.

Anilides↗
PubMed2004

Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee.

OBJECTIVE: To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject. METHODS: A consensus conference convened by the World Health Organization and the Societé Internationale d'Urologie met to critically review reports of the diagnosis and treatment of renal trauma. The English-language literature about renal trauma was identified using Medline, and additional cited works not detected in the initial search obtained. Evidence-based recommendations for the diagnosis and management of renal trauma were made with reference to a five-point scale. RESULTS: There were many Level 3 and 4 citations, few Level 2, and one Level 1 which supported clinical practice patterns. Findings of nearly 200 reviewed citations are summarized. CONCLUSIONS: Published reports on renal trauma still rely heavily on expert opinion and single-institution retrospective case series. Prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates the behaviour of practitioners.

Diagnostic Imaging↗
PubMed2003

Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa.

OBJECTIVES: To assess the feasibility of detecting early-stage prostate cancer in the primary healthcare setting, and to investigate whether there is a higher incidence of prostate cancer in Black African men. PATIENTS AND METHODS: The study was a collaboration with registrars in the authors' institutions and primary healthcare centres serving mainly a Black African or mixed ancestry (Coloured) population in the semi-urban Cape Town metropolitan area of South Africa. Men aged 50-70 years attending the clinics were counselled about prostate cancer and invited to have a digital rectal examination (DRE), serum prostate-specific antigen (PSA) assay and transrectal ultrasonography-guided sextant prostate biopsy if the DRE was clinically suspicious of malignancy or the serum PSA was > or = 4.0 ng/mL. An American Urological Association Symptom Index (AUA-SI) was obtained, and urine analysed using dipsticks. RESULTS: From May 2000 to November 2001, 660 men were assessed (mean age 59.4 years, range 30-82); 60.6% were Black African, 37.3% mixed (Coloured), 1.8% White (Caucasian) and 0.2% Asian (Indian). The mean (range) AUA-SI was 5.98 (0-35) in the whole group; the DRE was recorded as clinically suspicious of malignancy in 3.2%. The mean PSA was 20.39 (0.04-10 000) ng/mL in the whole group, but when two outliers (1865 and 10 000 ng/mL) were disregarded, it was 2.4 ng/mL. In Black patients the mean PSA was 31.8 (0.04-10 000) ng/mL, and without the outliers, 2.1 ng/mL; in Coloured patients it was 2.94 (0.05-50) ng/mL. The PSA was > or = 4.0 ng/mL in 9.6% of the whole group, in 7.8% of Black and in 13% of Coloured patients. Prostate biopsies were taken in 21 patients (3.2% of the whole group and a third of those with a PSA of > or = 4.0 ng/mL); in Black patients, biopsies were taken in 1.5% and 19.4%, respectively, and in Coloured patients in 6.1% and 46.9%, respectively. The prostate biopsy showed cancer in 43% of the whole group, in a third of Black and in 47% of Coloured patients; prostate cancer was detected in 1.4%, 0.5% and 2.8%, respectively. CONCLUSIONS: That prostate biopsies were obtained in only 19% of Black and in only 47% of Coloured men with a serum PSA of > or = 4.0 ng/mL is of concern. This indicates that there is a significant problem in getting men with an elevated serum PSA level to undergo a prostate biopsy in the primary healthcare setting in South Africa.

Adult↗
PubMed2003

Comparative efficacy of triptorelin pamoate and leuprolide acetate in men with advanced prostate cancer.

OBJECTIVE: To compare the efficacy of monthly administrations of the luteinizing hormone-releasing hormone agonists triptorelin pamoate and leuprolide acetate to induce and maintain castrate levels of serum testosterone in men with advanced prostate cancer. PATIENTS AND METHODS: Men with advanced prostate cancer were randomly assigned to receive triptorelin 3.75 mg or leuprolide 7.5 mg. The agent was injected intramuscularly every 28 days for nine injections. Primary endpoints were the percentages of men whose serum testosterone concentrations declined to and were maintained at or below castrate levels (</= 1.735 nmol/L or </= 500 ng/L) during 9 months (253 days) of treatment. Secondary endpoints were luteinizing hormone levels, bone pain, prostate specific antigen levels, quality of life, testosterone pharmacodynamics, survival, and safety variables. RESULTS: In all, 284 men received either triptorelin (140) or leuprolide (144). The percentage of men with castrate levels of serum testosterone was lower at 29 days for triptorelin than for leuprolide (91.2% vs 99.3%; point estimate - 8.0, 95% confidence interval - 16.9% to - 1.4%), but equivalent at 57 days (97.7% vs 97.1%). The mean (98.8% vs 97.3%) and cumulative (96.2% vs 91.2%) castration maintenance rates between 29 and 253 days were equivalent between the treatment groups. Secondary endpoints were equivalent between treatment groups except for the 9-month survival rate, which was significantly higher for triptorelin than for leuprolide (97.0% vs 90.5%; P = 0.033). Both treatments were well tolerated. CONCLUSION: Triptorelin reduced testosterone concentrations less rapidly, but maintained castration as effectively as leuprolide. There was no evidence that the slower onset of castration caused deleterious effects.

Aged↗
PubMed2002

Prospective evaluation of the American Urological Association symptom index and peak urinary flow rate for the followup of men with known urethral stricture disease.

PURPOSE: We prospectively evaluated the American Urological Association (AUA) symptom index and maximum urine flow for predicting urethral stricture recurrence in men with a previous diagnosis of urethral stricture disease. MATERIALS AND METHODS: Patients were recruited at our urethral stricture clinic, where all newly diagnosed and previously treated men with urethral stricture present and are treated. The AUA symptom index was completed and uroflowmetry was done. The stricture was calibrated using Jacques catheters. If an 18Fr catheter could not be passed, a retrograde urethrogram was performed. Patients were treated with filiform dilation or direct vision internal urethrotomy. Uroflowmetry was repeated when the catheter was removed 3 days later and the AUA symptom index was repeated 1 month later. RESULTS: Data on 49 patients (170 consultations) between March 2000 and August 2001 were analyzed. Average patient age was 48 years. There was a significant negative correlation of urethral diameter with AUA symptom index and of AUA symptom index with maximum urine flow as well as a significant positive correlation of urethral diameter with maximum urine flow. We evaluated the usefulness of AUA symptom index and maximum urine flow at different cutoff levels for predicting urethral stricture in our study group. Using an AUA symptom index of greater than 10 or maximum urine flow of less than 15 ml. per second as cutoff values provided 93% sensitivity, 68% specificity, 78% positive predictive value, 89% negative predictive value and 82% overall accuracy. This method could have prevented further invasive studies in 34% of patients, while a clinically significant stricture would have been missed in only 4.3%. CONCLUSIONS: AUA symptom index combined with maximum urine flow is an accurate, time-saving and cost-effective tool for predicting recurrent stricture in patients with a known urethral stricture. It can be used to direct decision making on further invasive studies and treatment.

Adult↗
PubMed2001

Early diagnosis of prostate cancer in the Western Cape.

BACKGROUND: Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer. OBJECTIVES: In view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men. PATIENTS AND METHODS: Men aged 50-70 years were invited by means of media communications (newspaper and radio) to attend our prostate clinic for a free physical examination, including a digital rectal examination (DRE) and serum prostate specific antigen (PSA) assay. If the DRE was clinically suspicious of malignancy and/or the serum PSA was > 4 ng/ml, the patient was appropriately counselled and referred for transrectal ultrasound (TRUS)-guided sextant prostate biopsy. RESULTS: In the period June 1997-September 1999 a total of 1,056 men attended the prostate clinic. Biopsies were indicated in 160 cases, and were obtained in 114 (71.3%, i.e. 10.8% of the entire cohort). Prostate cancer was detected on first biopsy in 3.5% of the entire group of men (in 35.9% of those with a clinically abnormal DRE, in 41.3% of those with a serum PSA > 4 ng/ml and in 88.6% of those with an abnormal DRE and serum PSA > 4 ng/ml. In the 37 men with prostate cancer, the clinical tumour stage was T1-2 in 83.8% and T3-4 in 16.2%. In the group of patients with clinical stage T1-2 tumours, the treatment was watchful waiting in 62.5% of cases, radiotherapy in 20.8% and radical prostatectomy in 16.7%. Analysis of the data according to race showed that in the group of 47 black men there was a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy, and a higher overall prostate cancer detection rate (8.5%). CONCLUSIONS: Our prostate cancer detection rate of 3.5% is slightly lower than that reported in larger studies (4.7%), which may be due to the fact that prostate biopsy was performed in only 71% of those who had an indication for biopsy. In the men diagnosed with clinically localised prostate cancer, potentially curative treatment was given in only 37.5% of cases. This compares unfavourably with the historical cohort of men seen at our oncology clinic, where 53% received potentially curative treatment, and a large European study where potentially curative treatment was given in 89% of cases. Our finding that black men had a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy and a higher overall detection rate of prostate cancer should be interpreted with caution, since black men comprised only 4.5% of our overall study cohort.

Aged↗
PubMed2001

Serum prostate-specific antigen as surrogate for the histological diagnosis of prostate cancer.

INTRODUCTION: To determine whether there is a cut-off value of serum prostate-specific antigen (PSA) which can be used confidently to make the diagnosis of prostate cancer, thereby obviating the need for biopsy. PATIENTS AND METHODS: During the period October 1991 to March 1998 the Department of Chemical Pathology at Tygerberg Hospital performed a total of 6,733 serum PSA assays on 3,960 patients. The histopathological and clinical diagnoses of these patients were obtained from records in the departments of Anatomical Pathology, Urological Oncology and Radiation Oncology. The serum PSA levels were correlated with the histopathology reports, using different PSA cut-off values ranging from 5 to 500 ng/ml, to calculate the sensitivity, specificity, and positive and negative predictive values of each cut-off value of PSA in predicting the presence of prostate cancer. RESULTS: In total, 3,837 (57%) of the 6,733 serum PSA assays were < or = 4 ng/ml, 1,045 (15.5%) of the assays were > or = 50 ng/ml, and 798 (11.9%) were > or = 100 ng/ml. Of the total of 3,960 individual patients, 531 (13.4%) had a serum PSA > or = 50 ng/ml and 423 (10.7%) had a PSA > or = 100 ng/ml. A serum PSA of > or = 30 ng/ml had a positive predictive value (PPV) of 90% at a specificity of 87% and sensitivity of 78%, while a PSA > or = 60 ng/ml had a PPV of 98% at a specificity of 98% and sensitivity of 65% for the presence of prostate cancer. The PPV reached 99% at a PSA > or = 100 ng/ml and 100% at a PSA > or = 500 ng/ml, with a specificity of 99% and 100%, but sensitivity of only 53% and 19%, respectively. CONCLUSIONS: A serum PSA > or = 60 ng/ml has a PPV of 98% for the presence of adenocarcinoma of the prostate, and may be used as a surrogate for histological diagnosis where facilities for obtaining prostatic biopsies are not readily available, thus decreasing costs and patient morbidity.

Aged↗
PubMed2001

Vesicosuspension for female stress incontinence and cystocele using pubic bone anchors.

OBJECTIVE: The purpose of this study was to evaluate the results of vesicosuspension for female stress incontinence and cystocele using fixation with pubic bone anchors in a cohort of patients operated on by a single surgeon. METHODS: Using a standard questionnaire, an independent female interviewer not employed by the surgeon's practice contacted 100 consecutive patients with stress incontinence and/or cystocele who had undergone vesicosuspension using suprapubic fixation with bone anchors between October 1996 and July 1997. The patients' responses were recorded on a computerised database and analysed. All procedures were performed by a single surgeon (A.J.V.). The duration of the operation was normally 45 minutes, the patient was mobilised on day 3 postoperatively, and the catheter removed on day 7. RESULTS: The mean age of the 100 women was 50.4 years (range 26-84 years) and the mean follow-up was 11 months (range 1.4-19 months). Previous operations for incontinence had been performed in 44 patients. Preoperatively 56 patients had to wear protective pads, using an average of 4.4 pads per day, and 36 had to change underwear because of urine leakage. Postoperatively 14 patients had to wear protective pads, using an average of 3.5 pads per day, while 11 had to change their underwear because of urine leakage. Only 3 patients used a catheter to empty the bladder, 2 used medication for incontinence, and none had had a subsequent operation for urine leakage. Postoperatively 16 patients reported having problems with pain in the pelvis, and 6 had pain during intercourse, but there were no cases of osteitis pubis. Subjective improvement reported by the patients was 93% on average, and overall patient satisfaction with the procedure was 8.6 on a scale of 0-10. In total, 89 patients said they would be prepared to undergo the operation again, while 92 would recommend it to a friend. CONCLUSION: The use of pubic bone anchors for colposuspension is safe and reliable, with results comparable to those of other methods, and the added advantages of faster mobilisation and few short-term complications.

Adult↗
PubMed1999

Influence of local tumour stage and grade on reliability of serum prostate-specific antigen in predicting skeletal metastases in patients with adenocarcinoma of the prostate.

OBJECTIVE: To determine whether serum prostate-specific antigen (PSA) can be reliably used to predict the absence or presence of skeletal metastases on the bone scan in patients with adenocarcinoma of the prostate. METHODS: We studied 450 consecutive men presenting with adenocarcinoma of the prostate between 1991 and 1995. Serum PSA was measured by the Hybritech Tandem-R monoclonal immunoradiometric assay and bone scanning was performed with 99m-technetium-labelled methylene diphosphonate. In total, 46 patients were excluded for one or more of the following reasons: serum PSA not available; radionuclide bone scan inconclusive; histology of the prostate other than adenocarcinoma; hormonal or other therapy given prior to obtaining the serum PSA and/or bone scan. RESULTS: Of the 404 patients included, 43% had poorly differentiated (grade 3), 74% had locally advanced (stages T3-4) tumours and 50% had skeletal metastases. The mean and median serum PSA were 348 and 52 ng/ml, respectively, and 77% of the patients had a serum PSA >20 ng/ml. The negative predictive value (for the absence of metastases on bone scan) of a serum PSA <20 ng/ml was 87% for the whole group of patients, 92, 94 and 70% for grade 1, 2 and 3 tumours, and 95, 83 and 50% for stage T1-2, T3 and T4 tumours, respectively. The positive predictive value (for the presence of metastases on bone scan) of a serum PSA >100 ng/ml was 80% for the whole group of patients. CONCLUSIONS: In patients presenting with adenocarcinoma of the prostate, serum PSA alone is not sufficiently reliable to predict the absence or presence of metastases on the radionuclide bone scan. In patients with grade 3 and clinical stage T3-4 tumours, a bone scan should be obtained for accurate staging, regardless of the serum PSA value.

Adenocarcinoma↗
PubMed1998

Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful?

PURPOSE: We evaluate the efficacy of repeated dilation or urethrotomy as treatment of male urethral strictures. MATERIALS AND METHODS: Between January 1991 and January 1994, 210 men with proved urethral strictures were prospectively randomized to undergo filiform dilation (106) or internal urethrotomy (104). Followup was scheduled at 3, 6, 9, 12, 24, 36 and 48 months. Dilation or internal urethrotomy was repeated at the first and second stricture recurrence. The Kaplan-Meier method was used to estimate survivor function for the treatment methods (survival time being the time to first stricture recurrence) and the log rank test was used to compare the efficacy of different treatments. RESULTS: Followup (mean 24 months, range 2 to 63) was available in 163 patients (78%). After a single dilation or urethrotomy not followed by re-stricturing at 3 months, the estimated stricture-free rate was 55 to 60% at 24 months and 50 to 60% at 48 months. After a second dilation or urethrotomy for stricture recurrence at 3 months the stricture-free rate was 30 to 50% at 24 months and 0 to 40% at 48 months. After a third dilation or urethrotomy for stricture recurrence at 3 and 6 months the stricture-free rate at 24 months was 0 (p <0.0001). CONCLUSIONS: Dilation and internal urethrotomy are useful in a select group (approximately 70% of all patients) who are stricture-free at 3 months, and of whom 50 to 60% will remain stricture-free up to 48 months. A second dilation or urethrotomy for early stricture recurrence (at 3 months) is of limited value in the short term (24 months) but of no value in the long term (48 months), whereas a third repeated dilation or urethrotomy is of no value.

Catheterization↗
PubMed1997

Carcinoma of the penis--appraisal of a modified tumour-staging system.

OBJECTIVE: To evaluate variables for the prediction of lymph node metastases in carcinoma of the penis, using a recently proposed modified tumour-staging system that combines the histological degree of differentiation and extent of local invasion of the primary tumour. PATIENTS AND METHODS: Thirty-five patients with squamous carcinoma of the penis and histo- or cytological staging of the inguinal lymph nodes were reviewed. A clinical TNM staging system was used in which the size (diameter) of the primary tumour and the clinical extent of invasion were considered. Subsequently, the tumours were also staged according to a modified T-system in which the histological degree of differentiation and pathological extent of tumour invasion were combined. RESULTS: Penectomy was performed in 34 patients (partial amputation in 20 and radical penectomy in 17). Inguinal lymphadenectomy was performed in 31 patients and in four the presence of lymph node metastases was confirmed by aspiration cytology. Using the clinical TNM staging system, lymph node metastases were histo- or cytologically present in no patients with T1, in five of 19 with T2, in 10 of 13 with T3 and in both patients with T4 tumours. Lymph node metastases were present in two of eight patients without clinically palpable inguinal nodes, in three of 14 with nodes clinically thought to be infective and in 11 of 12 nodes clinically considered to be malignant. Lymph node metastases were present in five of 17 patients with grade 1, in nine of 13 with grade 2 and in three of five with grade 3 tumours. Using the modified histological T-staging system (T1 = grade 1-2, invasive through dermis; T2 = any grade, invasion of corpus spongiosum or cavernosum; T3 = any grade, invasion of urethra; T4 = grade 3, regardless of invasion) lymph node metastases were present in one of nine patients with T1, in eight of 16 with T2, in all five with T3 and in three of five with T4 tumours. CONCLUSION: The modified T-staging system, which combines histological differentiation with pathological extent of invasion, provided the best predictive distinction between T1 and T2-4 tumours, indicating that lymphadenectomy can be avoided in T1 tumours, but should be performed in all patients with T2-4 tumours. We recommend bilateral inguinal lymphadenectomy 6-8 weeks after penectomy in such patients.

Adult↗
PubMed1997

Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison.

PURPOSE: We compared the efficacy of dilation versus internal urethrotomy as initial outpatient treatment for male urethral stricture disease. MATERIALS AND METHODS: A total of 210 men with proved urethral strictures was randomized to undergo filiform dilation (106) or optical internal urethrotomy (104) with local anesthesia on an outpatient basis. RESULTS: Life table survival analysis showed no significant difference between the 2 treatments with regard to stricture recurrence. Hazard function analysis showed that the risk of stricture recurrence was greatest at 6 months, whereas the risk of failure after 12 months was slight. The recurrence rate at 12 months was approximately 40% for strictures shorter than 2 cm. and 80% for those longer than 4 cm., whereas the recurrence rate for strictures 2 to 4 cm. long increased from approximately 50% at 12 months to approximately 75% at 48 months. Cox regression analysis showed that for each 1 cm. increase in length of the stricture the risk of recurrence was increased by 1.22 (95% confidence interval 1.05 to 1.43). CONCLUSIONS: There is no significant difference in efficacy between dilation and internal urethrotomy as initial treatment for strictures. Both methods become less effective with increasing stricture length. We recommend dilation or internal urethrotomy for strictures shorter than 2 cm., primary urethroplasty for those longer than 4 cm. and a trial of dilation or urethrotomy for those 2 to 4 cm. long.

Adolescent↗
PubMed1997

Cancer of the penis--a review of 50 patients.

We reviewed the management of 50 patients with cancer of the penis treated between November 1983 and April 1995 at Tygerberg Hospital. The mean patient age was 54 years. The race of the patient was mixed in 40, white in 8 and black in 2 cases. Serological tests were positive for syphilis in 8/18 (44%), and for human immunodeficiency virus (HIV) in 2/11 patients (18%) who were tested. Only 1 patient had been circumcised (at puberty). Penectomy was performed in 45 patients--partial amputation in 29 cases and radical penectomy in 20 (in 4 of these after previous partial penectomy with positive margins). Complications of penectomy occurred in 9 patients (20%). The histology of the primary lesion was squamous carcinoma in 46, verrucous carcinoma in 3 and melanoma in 1 patient. Differentiation of the tumour was good in 24, moderate in 15 and poor in 8; the grade was not recorded in 3 cases. The pathological T stage was Tis in 1 patient, T1 in 5, T2 in 24, T3 in 17 and T4 in 3 cases. Inguinal lymphadenectomy was performed in 34 patients at a median interval of 72 days after penectomy. Complications after lymphadenectomy occurred in 26 of the 34 patients (76%), but a second operation was required in only 5 cases (15%). In patients without clinically palpable inguinal nodes, cancer was present in 2/8 (25%) specimens. In patients with clinically palpable inguinal nodes, metastases were present in 16/29 (55%)--in 4/16 (25%) of nodes clinically thought to be infective, and in 12/13 (92%) of nodes considered to be malignant. Lymph node metastases were present in 0/2 patients with T1, in 5/19 (26%) with T2, in 12/15 (80%) with T3 and in 3/3 (100%) with T4 tumours. At a mean follow-up of 22 months in 39 patients 62% were alive without evidence of disease, 23% were alive with carcinoma and 15% were dead. Death and recurrence or metastases were significantly more common in patients with T3-4 compared with T1-2 tumours, and in those with N1-3 compared to NO disease, but tumour grade had no significant effect on outcome. Death and recurrence or metastases were also more common in cases where the surgical margin at penectomy was involved with tumour. In conclusion, our patients presented at a relatively young age with locally advanced tumours and a high incidence of inguinal lymph node metastases. In patients with locally advanced tumours we recommend ablative surgery with bilateral inguinal lymphadenectomy 6-8 weeks after penectomy. We avoid pelvic lymph node dissection, since this does not improve the prognosis, while increasing the risk of complications, especially lower limb oedema.

Adult↗
PubMed1997

Outpatient treatment for male urethral strictures--dilatation versus internal urethrotomy.

Male patients with proven urethral strictures (total 210) were prospectively randomised to undergo either dilatation (106 patients) or internal urethrotomy (104 patients) as an outpatient procedure under local anaesthesia. The incidence of complications or failure during the performance of the procedure did not differ significantly between the two treatment groups. Complications or failure in performing urethral dilatation were significantly more common in patients who presented with retention or complications compared with symptoms only, and in those with a positive compared with negative urine cultures. Complications or failure in performing internal urethrotomy were significantly more common in patients with a positive than with a negative urine culture, and long (> 2 cm) rather than short (< 2 cm) strictures, whereas the difference approached significance for patients with multiple rather than single strictures (P = 0.06). Failure alone in the performance of internal urethrotomy was significantly more common in patients with trauma compared with urethritis as aetiology, and in those without previous stricture treatment. With a mean follow-up of 15 months the cumulative percentage of recurrent urethral strictures did not differ significantly between the two treatment groups. We conclude that urethral dilatation and optical internal urethrotomy under local anaesthesia are equally successful as initial outpatient treatment. With regard to successful performance of the procedure itself, multiple, longer (> 2 cm), post-traumatic, and previously untreated strictures are better managed with dilatation, whereas patients with complications or retention are better managed with internal urethrotomy. A positive urine culture is associated with a higher complication and failure rate in the performance of both procedures.

Adolescent↗