Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis

Abstract

BackgroundThe use of internal urethrotomy for treatment of urethral stricture remains a controversial topic in urology. ObjectiveTo investigate outcomes and predictors of failure for internal urethrotomy as primary treatment for untreated bulbar urethral strictures. Design, setting, and participantsWe performed a retrospective analysis of patients who underwent internal urethrotomy. Patients with bulbar urethral stricture who did not receive any previous treatment were included. Patients with traumatic, penile or posterior urethral strictures, lichen sclerosus, failed hypospadias repair, or stricture length >4cm were excluded. Outcome measurements and statistical analysisThe primary outcome was treatment failure. Kaplan-Meyer plots were used to depict treatment failure–free survival. Univariate and multivariable Cox regression analyses were used to test the association between predictors (age, body mass index, diabetes, history of smoking, etiology, stenosis type and length, preoperative maximum flow [pQmax]) and treatment failure. Results and limitationsOverall, 136 patients were included. The median stricture length was 2cm. Median follow-up was 55 mo. At 5-yr follow-up the failure-free survival rate was 57%. On univariate analysis, diabetes, nonidiopathic etiology, stricture length of 3–4cm, and pQmax were significantly associated with treatment failure. These predictors were included in a multivariable analysis, in which pQmax was the only significant predictor of treatment failure. ConclusionsFailure of internal urethrotomy for untreated bulbar urethral strictures greatly depends on pQmax flow at uroflowmetry. Patients with pQmax >8ml/s have a high probability of success, while patients with pQmax <5ml/s have a low probability of success. Patient summaryThe use of internal urethrotomy in patients with an untreated bulbar urethral stricture should only be considered in selected cases.