Urethral stricture disease (USD) is a common urologic condition, often resulting from iatrogenic causes such as catheter trauma, transurethral procedures, or prostate surgery (Lumen et al., 2009). It leads to urethral narrowing, obstructing the lower urinary tract. The prevalence in industrial countries is around 0.9%, but data in the Philippines is limited (Anger et al., 2011). Treatment options vary between surgical (urethroplasty) and endoscopic methods (urethrotomy), with urethrotomy being the most common. However, recurrence remains a major challenge, especially for extensive or previously treated strictures (MacDonagh, 1988; Steenkamp et al., 1997). Intermittent urethral dilatation, a method introduced in the 1980s, helps prevent recurrence by keeping the stricture from re-narrowing post-surgery (Ivaz et al., 2016). This study aims to evaluate the efficacy and safety of intermittent catheterization after urethrotomy to prevent stricture recurrence.

A systematic review and meta analysis be conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analysis) guidelines during the preparation of this meta analysis (Higgins et al., 2011). All steps will be carried out accor ding to the Cochrane Handbook for Systematic Reviews of Interventions.

The study reviewed nine eligible trials on intermittent catheterization (IC) involving 705 patients, all reporting on urethral stricture recurrence. Among these, four were randomized trials and five were comparative studies. IC was performed with an average duration of 11.33 ± 7.85 months; controls received no intervention. Six studies reported adverse events. Risk of bias (ROB) for randomized trials was assessed using the ROB 2 tool: one study (Kjaeggard 1994) had low risk, one had some concerns (Bhatta 2020), and two had high risk (Khan 2011, Kumar 2019). Non-randomized trials were assessed using ROBINS-I, revealing an overall moderate risk of bias for most studies. Afridi 2010, Bodker 1992, Greenwell 2015, and Tricard 2015 had moderate overall ROB, while Hussmann 2006 was rated low ROB. Common concerns included bias due to confounding, intervention classification, and lack of information in some domains.

In conclusion, this study has shown that performing intermittent catheterization after urethrotomy was able to reduce the risk of recurrence of urethral strictures in the adult population. It is a simple and safe option to resolve the obstruction and its associated symptoms while maintaining continence. However, this benefit must be leveraged against the burden of performing the procedure. It is not yet known whether performing intermittent catheterization improves health-related quality of life or is cost-effective versus doing nothing at all after urethrotomy. It is also unknown whether benefit of catheterization is long lasting even after it has been discontinued. Future studies are recommended specifically on patient-reported and health economic outcome measures.