Introduction: Results from direct vision internal uretrotomy (DVIU) for the treatment of urethral strictures are contradictory in the literature, with recurrence rate ranging from 8 to 88%. The principal aim of the study is to evaluate the predictive factors of urethral stricture recurrence after a first DVIU based on patient’s, stricture’s characteristics and peri operative data.
Methods: Data of patients who underwent DVIU for a first episode of urethral stricture between January 2000 and July 2020 in urological department of Charles Nicolle hospital was retrospectively obtained. Kaplan-Meier curves were used to depict recurrence free survival. Univariate cox regression analysis was used to identify independent predictive factors of recurrence after a first DVIU. All tests were two sided and significance was set to 0.05.
Results: Overall, 633 patients were included out of 925. Mean age was 62-year-old (16-92). For a mean time of follow up of 62 months, global recurrence rate was 49%. As patient’s characteristics, renal failure (p=0.014) and anemia (p=0.001) were associated with recurrence. For stricture’s characteristics, post traumatic origin(p < 0.001), penile location (p=0.006), multiple stensosis (p=0.002), stricture length (p < 0.001), obliterant stricture (p < 0.001) and peri-urethral scar (p < 0.001) were correlated with recurrence. Difficult procedure (p < 0.001), false passage (p < 0.001), catheter type (p=0.031), catheter diameter (p=0.031), duration of catheterization >5days (p < 0.001) as well as postoperative urinary tract infection (p=0.043) were associated with recurrence. Post-operative intermittent catheterization (p < 0.001) and a duration intermittent catheterization >6months were correlated to the success of the procedure.
Conclusions: A short, single, bulbar urethral stricture with no narrow neither scarring tissue is associated with the success of DVIU. A latex catheter with small diameter for a period of more than five days is associated with recurrence. Intermittent catheterization postoperatively is recommended for a period of at least six months to avoid recurrences.
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