Is repeated direct vision internal urethrotomy feasible in the management of recurrent anterior urethral strictures?

Purpose: Direct vision internal urethrotomy (DVIU) is the most common surgical intervention for anterior urethral strictures. We evaluated the long-term outcome and success rate of optic urethrotomy in patients treated in our hospital who had recurrent anterior urethral strictures, according to different predisposing causes and stricture sites. The aim is to find the success rate of optic urethrotomy in patients treated who had recurrent anterior urethral strictures. Materials and Methods: This study is a retrospective chart review. From January 2000 to August 2017, 232 patients received internal optic urethrotomy for anterior urethral strictures in our hospital. A retrospective chart review of all patients involved in the study was performed. Median follow-up period after receiving the first urethrotomy procedure was 91 months (range: 8-204 months). The Kaplan-Meier method was used to analyze the success rate of the first, second, third, fourth, and fifth urethrotomy procedures. Results: Of the 232 patients who underwent at least two procedures of urethrotomy, 150 (64.65%) were included in the study. The success rate of the first urethrotomy procedure was 0%, with a mean time to recurrence of 20 months. For the second urethrotomy, the success rate was 53%, with a mean time to recurrence of 22.5 months. For the third urethrotomy, the success rate was 40%, with a mean time to recurrence of 16.1 months. For the fourth and fifth urethrotomy procedures, the success rate was 39% and 18%, with a mean time to recurrence of 17.9 and 10.2 months, respectively. Patients who had anterior urethral stricture related to previous surgery (surgery-related) had a better outcome (success rate, 87.3%) than patients with strictures stemming from other causes (P = 0.003). No association was found between preoperative infection, the age of the patient, and the site of the strictures and the success rate of the procedure. Conclusion: The patient population was older and had a longer-term follow-up, compared with previous studies, but even with repeated DVIU, the surgery-related stricture group had a higher success rate of urethrotomy than the groups with different etiology. In patients with pelvic fracture or infection, repeated urethrotomy may not be recommended as first-line treatment for recurrent anterior urethral stricture.