Minimally invasive methods for bulbar urethral strictures: a survey of members of the American Urological Association

Abstract

Objective: To determine current practice patterns, we mailed a questionnaire regarding urethral stricture evaluation, treatment, and follow-up to members of the American Urological Association (AUA). The minimally invasive methods used for treating and evaluating anterior urethral strictures vary widely among clinicians.

Methods: A nationwide survey of practicing members of the AUA was performed by mailed questionnaires. Surveys were mailed to 1262 Urologists, randomly selected from all 50 states. Four-hundred thirty-one urologists (34%) completed the questionnaire and formed the basis for our analysis.

Results: Most urologists (63%) treat 6-20 urethral strictures per year. The most common minimally invasive procedures used for managing anterior urethral strictures were dilation (92.8%), cold-knife optical internal urethrotomy (85.6%), endourethral stent (23.4%), laser urethrotomy (19%), and periurethral steroid injection after urethrotomy (7.9%). Most urologists will perform urethrotomy on bulbar strictures up to 2 cm (68.7%) and leave a Foley catheter in place for 1 week or less (86.5%). Technical method of urethrotomy is commonly 1 cut at 12 o'clock (86.3%) or radial cuts (12.1%). Recommended follow-up diagnostic tests after urethrotomy included flow rate (62.9%) and, to a lesser degree (with roughly one-third each), cystoscopy, urethral calibration, and the International Prostate Symptom Score (IPSS). Other tests, such as ultrasonography or urethrography were rarely used.

Conclusion: Our survey provides information regarding current minimally invasive management and follow-up practice strategies recommended by members of the AUA for anterior urethral strictures. Many common practices in the treatment of anterior urethral stricture disease are not supported in the literature.