Poor Quality of Life in Patients with Urethral Stricture Treated with Intermittent Self-Dilation

Purpose: We assessed patient perceptions of regular intermittent self-dilation in men with urethral stricture. Materials and Methods: We constructed and distributed a visual analog questionnaire to evaluate intermittent self-dilation via catheterization by men referred for urethral stricture management at a total of 4 institutions. Items assessed included patient duration, frequency, difficulty and pain associated with intermittent self-dilation as well as interference of intermittent self-dilation with daily activity. The primary outcome was patient perceived quality of life. Multivariate analysis was performed to assess factors that affected this outcome. Results: Included in the study were 85 patients with a median age of 68 years, a median of 3.0 years on intermittent self-dilation and a median frequency of 1 dilation per day. On a 1 to 10 scale the median intermittent self-dilation difficulty was 5.0 +/- 2.7, the median pain score was 3.0 +/- 2.7 and median interference with daily life was 2.0 +/- 1.3. Overall quality of life in patients with stricture was poor (median score 7.0 +/- 2.6 with poor quality of life defined as 7 or greater). On univariate analysis younger age (p < 0.01), interference (p = 0.03), pain (p < 0.01) and difficulty performing intermittent self-dilation (p = 0.03) correlated with poor quality of life in a statistically significant manner. On multivariate analysis only difficulty catheterizing (p < 0.01) and younger age (p = 0.05) were statistically significant predictors. Patients with stricture involving the posterior urethra had a statistically significant increase in difficulty and decrease in quality of life (each p = 0.04). Conclusions: Most patients with urethral stricture who are on intermittent self-dilation rate difficulty and pain as moderate, and inconvenience as low but report poor quality of life.