Outcomes and predictive factors of recurrence after endoscopic management of male bulbar urethral stricture at a Tertiary Care Centre.

Introduction: Male urethral stricture is a common clinical condition in urology with significant socioeconomic impacts and is associated with high recurrence rates.Visual internal urethrotomy (VIU) is a widely used endoscopic treatment for short-segment urethral strictures (<2 cm). The aim of this study was to evaluate the stricture-free rates and analyze the predictive factors for recurrence after VIU, following both initial and repeated urethrotomies, with 12 months of follow-up.

Methods: This retrospective study included male patients who underwent VIU for urethral stricture disease between January 2021 and July 2023. Statistical analysis was performed using MedCalc software (version 22.00). Univariate analyses were conducted using the Chi-square test for categorical variables and the -test for continuous variables.

Results: A total of 132 patients with a mean age of 39.8 years were included in the study, with a follow-up duration of 12 months. The mean stricture length was 12 mm, and the most common site of stricture was the bulbar urethra. The stricture-free rate following the first VIU was 59.7%, with a mean time to recurrence of 6.7 months. After the second VIU, the stricture-free rate decreased to 45.5%, with a mean time to recurrence of 5.2 months. The cumulative stricture-free rate at 12 months (following both first and second VIU) was 80.3%, with a mean time to recurrence of 7.9 months (range: 4-11 months). Patients who experienced recurrence after the second VIU underwent definitive urethroplasty. Intraoperative factors significantly influenced the outcomes of VIU, including stricture length (<2 cm vs >2 cm,  = 0.045), health of the urethral mucosa (healthy vs unhealthy,  = 0.250), presence of spongiofibrosis (present vs absent,  = 0.07), and stricture location (mid-bulbar urethral stricture in 74 patients [56.09%], penobulbar/distal bulbar urethral stricture in 50 patients [37.8%], and bulbomembranous/proximal bulbar urethral stricture in eight patients [6.09%]).

Conclusions: Although VIU is a relatively simple procedure, it yields acceptable outcomes in carefully selected patients. Stricture length and the presence of spongiofibrosis had a statistically significant impact on outcomes. Other independent predictive factors for failure of VIU included older age, obesity, and mucosal health.