Newly diagnosed bulbar urethral strictures: etiology and outcome of various treatments

A retrospective review was performed of 199 consecutive patients who were evaluated at this institution between 1976 and 1990 because of a newly diagnosed bulbar urethral stricture. Mean patient age at diagnosis was 64 years (range 10 to 96) and most patients presented with obstructive symptoms. The stricture etiology was primarily iatrogenic (47%), secondary to a transurethral procedure. The strictures were usually short (less than 2 cm., 96%), single (99%) and located in the proximal bulb (57%). Of the 151 patients receiving treatment at the time of initial diagnosis 101 (67%) underwent urethral dilation, 39 (26%) were managed with direct vision internal urethrotomy and in 11 (7%) a cystotomy tube was placed. With a median followup of 3.5 years (range 0 to 16), there was an estimated retreatment rate of 2.4 treatments per 10 person-years. The probability of not requiring retreatment within 3 years was 65 +/- 5% for urethral dilation and 68 +/- 8% for direct vision internal urethrotomy. When compared to urethral dilation, direct vision internal urethrotomy resulted in a higher incidence of postprocedure cystitis (5% versus 3%), epididymitis (5% versus 3%) and penile hemorrhage (8% versus 2%). These findings indicate that both conservative therapies were equally efficacious as an initial treatment of bulbar urethral stricture. However, direct vision internal urethrotomy did have a slightly higher complication rate. No specific patient or stricture characteristics could be identified that were reliable for predicting therapeutic outcome.