Management of urethral stricture: translating guidelines into clinical practice

Despite well-defined standards for urethral stricture management, significant practice variations persist. This survey assessed guideline adherence among Turkish urologists.

An online SurveyMonkey survey was sent to Turkish Urological Association members, open October 10-17, 2021, with two reminders. Data were centrally collected and analyzed using descriptive statistics.

Of 2,078 members, 222 (11%) responded, mostly aged 30-45 years. Retrograde urethrography (26%), uroflowmetry (90%), and cystourethroscopy (61%) were used for diagnosis, with academic urologists employing these more often (p < 0.05). Blind dilatation with metal bougies (47%) exceeded plastic dilators over guidewire (23%) or disposable catheters (26%). Material preference was unrelated to experience (p = 0.39), but non-metal methods were more common in academic centers (p = 0.04). For 1-2 cm primary bulbar strictures, 7% chose urethroplasty, while 72% preferred Direct Vision Internal Urethrotomy (DVIU) with dilatation. Academic urologists performed more urethroplasties (p = 0.01). In recurrent cases, 76.5% performed DVIU ≥ 4 times, and 79.3% recommended periodic post-DVIU dilatation.

Urologists' approaches to urethral strictures often deviate from guidelines. Retrograde urethrography use is low, metal bougies dominate dilatation, and urethroplasty is underused, favoring repeated DVIU and dilatation. Academic urologists adhere more to guideline recommendations than non-academic peers.