Chronic urethritis accompanied by recurrent urinary tract infections (UTIs) poses a challenging clinical dilemma in women's healthcare. Traditional treatments like urethral dilatation and medical therapy often fall short in providing sustained relief for patients with frequent symptoms. Internal urethrotomy, particularly employing the Otis urethrotome, has emerged as a potential solution, although its efficacy remains a subject of debate due to conflicting evidence.

A comprehensive review of literature was conducted to evaluate the efficacy of internal urethrotomy in managing chronic urethritis and recurrent UTIs in women. PubMed, MEDLINE, and other pertinent databases were comprehensively searched using relevant keywords such as "chronic urethritis," "recurrent cystitis," "internal urethrotomy," and "Otis urethrotome." Peer-reviewed studies published from inception to present were included, and relevant articles were selected based on their relevance and quality of evidence.

Internal urethrotomy, particularly employing the Otis urethrotome, demonstrated promising results in addressing recurrent UTIs and chronic urethral symptoms in women. A comprehensive analysis of relevant studies revealed subjective improvement in a significant proportion of patients post-procedure, with cure or improvement rates ranging from 60% to 90%.

Farrar et al. conducted a study where they observed subjective improvement in 90% of patients at six months post-internal urethrotomy, with sustained improvement noted in 85% at 12 months and 75% at more than two years' follow-up. Similarly, Schilling et al. reported significant improvement in 60% of women experiencing sterile dysuria complaints after undergoing internal urethrotomy.

Further investigations by Smith et al. provided insights into the efficacy of internal urethrotomy in managing chronic urethritis. They reported a good postoperative result in 61% of 40 women with chronic urethritis, and 53% of women with urethritis and recurring infections experienced improvement post-procedure. Additionally, Taylor et al. explored the effects of diathermy to the trigone and upper urethra in the female urethral syndrome. Their findings revealed superior outcomes with the addition of diathermy compared to cystoscopy alone, with 45% of patients experiencing no further attacks and 90% deeming the treatment worthwhile at a 3-year follow-up.

Vermillion et al. reported favorable therapeutic results with internal urethrotomy combined with 3 months of appropriate drug therapy, resulting in no recurrent infections in 78% of 106 patients during a 2-year follow-up period. However, Choa et al. found no significant difference between urethral dilatation and cystoscopy in terms of treatment outcomes, although symptoms improved in 72% after urethrotomy compared to 46% after cystoscopy.

Moreover, studies by Netto et al. and Kapland et al. provided insights into the comparative efficacy of medical versus surgical interventions. Netto et al. observed superior outcomes with medical treatment compared to surgical-medicinal treatment for recurring cystitis in women, while Kapland et al. found no difference in outcomes among treatment regimens consisting of antibacterial therapy plus urethral dilation, internal urethrotomy, or medication alone.

Despite extensive research, there remains uncertainty regarding the efficacy of urethral dilatation. Rutherford et al. observed no significant difference in outcomes between cystoscopy alone and cystoscopy plus urethral dilatation, with the latter associated with transient stress incontinence of urine in some cases.

The findings suggest that internal urethrotomy holds potential in providing symptomatic relief and preventing recurrent UTIs in women with chronic urethritis. Despite conflicting evidence regarding the efficacy of urethral dilatation, internal urethrotomy appears to offer favorable outcomes in a significant proportion of cases. However, the choice between medical and surgical interventions remains contentious, necessitating further investigation.

Internal urethrotomy, particularly utilizing the Otis urethrotome, represents a promising therapeutic option for managing chronic urethritis and recurrent UTIs in women. While traditional treatments may offer symptomatic relief, internal urethrotomy appears to provide substantial subjective improvement and infection prevention in a considerable number of cases. Further research is warranted to establish standardized protocols and optimize patient outcomes in this complex clinical scenario.

Farrar DJ et al. An evaluation of Otis urethrotomy in female patients with recurrent urinary tract infections. Br J Urol. 1973;45:610–615.
Schilling A et al. The dysuria syndrome. Significance of urethral diameter for recurrent bacterial cystitis in the female [in German]. Gynakol Rundsch.
Smith GI et al. Clinical experience in 40 women. Urology. 1973;2(2):144–147.