Home Self-Dilation for Urethral Strictures
No, most urethral strictures should not be stretched by patients at home as initial treatment, but self-catheterization may be recommended after direct visual internal urethrotomy (DVIU) in select patients who are not candidates for urethroplasty. 1
When Self-Dilation Is Appropriate
Self-catheterization at home has a limited but specific role in urethral stricture management:
Self-catheterization may be recommended only AFTER initial DVIU in patients who are not candidates for urethroplasty to maintain temporary urethral patency. 1
Duration matters for effectiveness: Self-catheterization performed for greater than 4 months after DVIU significantly reduces recurrence rates compared to less than 3 months of self-catheterization. 1, 2
This is a temporizing measure, not definitive treatment: Self-dilation maintains patency but does not cure the stricture—it simply delays recurrence in patients who cannot undergo definitive surgical repair. 1
Why Most Strictures Should NOT Be Self-Dilated at Home
The evidence strongly argues against home self-dilation as primary or repeated treatment:
Repeated endoscopic treatments (including dilations) have >80% failure rates for recurrent strictures and may cause longer strictures that increase the complexity of subsequent urethroplasty. 1, 2
Success rates are poor for most stricture types: Endoscopic treatment success ranges only 35-70% for short (<2 cm) bulbar strictures, with particularly poor outcomes for strictures ≥2 cm in length and penile urethral strictures. 1, 2
Urethroplasty should be offered instead of repeated endoscopic management for recurrent anterior urethral strictures, with success rates of 90-95% compared to the dismal outcomes of repeated dilation. 1
The Proper Treatment Algorithm
For initial presentation:
- Short (<2 cm) bulbar strictures may be treated with initial dilation or DVIU (success 35-70%). 1, 2
- Strictures ≥2 cm should be offered urethroplasty as initial treatment due to low success with endoscopic approaches. 2
- Penile urethral strictures should undergo urethroplasty due to high recurrence with endoscopic treatment. 2
For recurrent strictures:
- Urethroplasty should be offered rather than repeated dilation, as failure rates exceed 80% with repeated endoscopic treatment. 1, 2
For patients who cannot undergo urethroplasty:
- Perform DVIU first, then consider self-catheterization for >4 months to maintain temporary patency. 1, 2
Critical Pitfalls to Avoid
Never recommend repeated home dilations for recurrent strictures—this leads to longer, more complex strictures that are harder to repair surgically. 1, 2
Avoid self-dilation without prior professional intervention—patients need proper stricture characterization (length, location) via retrograde urethrography or cystoscopy before any treatment decision. 1
Do not use self-dilation as a substitute for definitive treatment in surgical candidates—urethroplasty provides vastly superior long-term outcomes (90-95% success) compared to any form of repeated dilation. 1, 2
Patients dependent on indwelling catheters or chronic self-dilation may benefit from suprapubic cystostomy placement prior to definitive urethroplasty to allow "urethral rest" and proper stricture maturation over 4-6 weeks. 1