Urethral narrowing and its treatment: a possible solution for the problems of recurrent urinary infection and the "irritable bladder".

A surgical treatment for longstanding urinary and pelvic complaints of women is described and evaluated. The procedure includes urethral dilatation to 40 F and "snowplowing" (dull curettage) of urethral, bladder neck, and trigonal mucosa with the heel of the cystoscope, removing granulated tissue, polyps, and villous fronds, and unroofing infected periurethral glands. Vigorous urethral massage is performed, and the patient is hospitalized overnight with large-catheter drainage to continue dilatation. Follow-up dilatations in the office are essential. The procedure was evaluated by comparing presenting and post-treatment symptoms for each patient and by asking each patient to rate the effectiveness of the treatment. Results suggest that treatment is very effective, with 80 per cent of respondents rating it either excellent or good.