Direct Visual Internal Urethrotomy for the Management of Partial Urethral Strictures: Is it a Viable Treatment Option?

Abstract

Context: Direct Visual Internal Urethrotomy (DVIU) has been a useful tool in the management of partial urethral strictures. There is limited data on its success rates in black populations. A successful DVIU will spare the patient the stress and rigours of undergoing a urethroplasty. This study intends to look at the outcomes of DVIU in our setting using uroflometry.

Materials and Methods: This is an observational prospective study of 58 patients that underwent DVIU for short segment anterior Urethral strictures between January 2020 and January 2024 recruited using a consecutive sampling technique.. Patients were monitored after discharge through phone calls and post operative visits.

Results: A total of 58 patients were involved in the study with a mean age of 65 years and mean BMI of 26.4 ± 3.2. Stricture of unknown aetiology (idiopathic) accounted for majority of the cases 31 (53.4%) followed by iatrogenic stricture, 11(19.0%) of all strictures. Traumatic stricture was responsible for (7) 12.1%, inflammatory (6) 10.3% while stricture due to malignancy accounted for 3(5.2%) of all cases The commonest stricture location was the proximal bulbar 36 (62.1%) followed by penile and distal bulbar representing (19%) of the strictures. Most of the patients 39 (67.2%) had a single stricture. The mean maximum flow rate pre DVIU was 9.6 ml/sec ±1.5 and the maximum flow rate at 6 months post DVIU was 29.3 ml/sec ± 6.1 representing an increase by 19.7ml/sec (95% CI 0.7 - 5.3) compared to the pre-intervention period (p=0.0059).

Conclusion: DVIU seems to be a viable treatment option for patients with partial urethral strictures in our environment. Longer follow up of these patients may be required to substantiate our findings.