DIRECT VISUAL INTERNAL URETHROTOMY (DVIU) FOR UNTREATED BULBAR URETHRAL STRICTURES. A SOLUTION?

:Urethral stricture diseases have been treated with numerous approaches. Though openurethroplasty is considered a one-time solution [1], The direct visual internal urethrotomy (DVIU) is stillconsidered an alternative approach in the stepladder of treatment [2,3]. Here we report our experience at a tertiary carehospital with DVIU in a homogeneous series of patients with bulbar urethral stricture who underwent strict follow-up andpresent a multivariable analysis of the results to identify signicant predictors of treatment failure. We wish to offer new insightsinto DVIU. Materials and method: We performed a retrospective analysis of patients who underwent internal urethrotomy.Patients who underwent DVIU for untreated bulbar urethral strictures with minimum follow-up of 12 months were included.Patients with traumatic stricture and stricture length >4 cm were excluded.The primary outcome was treatment failure.Multivariable Cox regression analyses by Stata v.12.0 were used to test the association between predictors:- Stricture etiology,stenosis length, preoperative maximum ow [pQmax]) and treatment failure. Results: 215 patients were included. Medianfollow-up was 35 months. At 5-yr follow-up the failure-free survival rate was 54.4%. On multivariable analysis pQmax was theonly signicant predictor of treatment failure. Conclusions: DVIU success rate for untreated bulbar urethral strictures wassignicantly associated with preoperative maximum ow rate. The patients with a pre- operative maximum ow lesser than 6ml/s have a low probability of success and may be considered for alternative treatments such as open urethroplasty, especiallywhen affected by long urethral strictures.