Direct Vision Internal Urethrotomy for Short Anterior Urethral Strictures and Beyond: Success Rates, Predictors of Treatment Failure and Recurrence Management

OBJECTIVES: To determine success rates, predictors of recurrence and recurrence management of patients treated for short anterior urethral strictures by direct vision internal urethrotomy (DVIU).

METHODS: We identified 128 patients who underwent DVIU of the anterior urethra between December 2009 and March 2016. Follow-up was conducted by telephone interviews. Success rates were assessed by Kaplan-Meier estimators. Predictors of stricture recurrence and different further therapy strategies were identified by uni- and multivariable Cox regression analyses.

RESULTS: Mean age was 63.8 years (standard deviation (SD): 16.3) and the overall success rate was 51.6% (N=66) at a median follow-up of 16 months (interquartile range (IQR): 6-43). Median time to stricture recurrence was six months (IQR: 2-12). In uni- and multivariable analyses, only repeat DVIU (hazard ratio (HR)=1.87; 95% confidence interval (CI)=1.13-3.11; P=0.015 and HR=1.78; 95% CI=1.05-3.03; P=0.032, respectively) was a risk factor of recurrence. Of 62 patients with recurrence, 35.5% underwent urethroplasty, 29% underwent further endoscopic treatment and 33.9% did not undergo further interventional therapy. Age (HR=1.05; 95% CI=1.01-1.09; P=0.019) and diabetes (HR=2.90; 95% CI=1.02-8.26; P=0.047) were predictors of no further interventional therapy.

CONCLUSIONS: DVIU seems justifiable in short urethral strictures as primary treatment. Prior DVIU was a risk factor of recurrence. In case of recurrence, about one third of patients did not undergo any further therapy. Higher age and diabetes predicted the denial any further treatment.