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

Abstract 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.