Management of Adult Anterior Urethral Stricture Disease: Nationwide Survey Among Urologists in The Netherlands

• Published in: European urology 2011-07, Vol.60 (1), p.159-166
• Main Authors: van Leeuwen, Menno A, Brandenburg, Jacob J, Kok, Esther T, Vijverberg, Peter L.M, Bosch, J.L.H. Ruud
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Netherlands; Practice Patterns, Physicians; Stricture; Surveys and Questionnaires; Treatment; Urethra; Urethral Stricture - surgery; Urethroplasty; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2011.03.016

Abstract Background Adult anterior urethral stricture disease is most often treated with dilatation or direct vision internal urethrotomy (DVIU). Although evidence suggests that anastomotic urethroplasty for short bulbar strictures is more efficient and cost effective in the long term, no consensus exists. It is unclear by whom and how often urethroplasties are performed in The Netherlands and how results are being evaluated. Objective To determine national practice patterns on management of anterior urethral strictures among Dutch urologists. This information will help to define the nationwide need for training in urethral surgery. Design, setting, and participants We conducted a 16-question survey among all 323 Dutch urologists. Results and limitations The response rate was 74%. DVIU was practised by 97% of urologists. Urethroplasty was performed at least once yearly by 23%, with 6% performing more than five urethroplasties annually. In the group of urologists younger than 50 yr of age, 13% performed urethroplasty, with 3% of those performing more than five annually. In the case of a 3.5-cm-long bulbar stricture, DVIU was preferred by 49% of responders. Even after two recurrences, 20% continued to manage a 1-cm-long bulbar stricture endoscopically. Of responders, 79% believed that urethroplasty should be proposed only after a failed endoscopic attempt. Diagnostic workup and evaluation of success varied greatly. Conclusions Most Dutch urologists believe that urethroplasty is an option only after failed DVIU. Endoscopic procedures are widely used, even when the risk of recurrence is virtually 100%. The definition of success is hampered by nonstandardised methods of follow-up. Only a small group of mainly older urologists frequently performs urethroplasties. Training programmes seem necessary to guarantee a high standard of care for stricture disease in The Netherlands. A pan-European practice survey might be interesting to clarify the need for centralised fellowship programmes.