PREDICTORS FOR FAILURE OF DIRECT VISION INTERNAL URETHROTOMY (DVIU) FOR SINGLE AND SHORT BULBAR URETHRAL STRICTURES? A FACT OR FALLACY

Abstract

Aims & Objectives: To identify patient and stricture characteristics predicting failure after direct vision internal urethrotomy (DVIU) for single and short (<2 cm) bulbar urethral strictures. Materials & methods: We retrospectively analysed 1260 adult patients who underwent DVIU between September 2007 to January 2021 in the Department of Urology,Institute of Nephrourology(INU),Bangalore. The patients' demographics and stricture characteristics were analysed. The primary outcome was procedure failure, dened as the need for regular self-dilatation (RSD), redo DVIU or substitution urethroplasty. Predictors of failure were analysed. For association between categorical variables, the chi-square test was used, while the Student's t-test was used for comparing means between groups. Logistic regression analysis was used to determine independent predictors of failure after DVIU. All statistical analysis was performed using SPSS statistical software, with a P< 0.05 considered to indicate statistical signicance. Results & Observations:In all,1260 adult patients with a mean (SD) age of 48.3 years were included. The main causes of stricture were idiopathic followed by iatrogenic in 48.3% and 29.4 % of patients, respectively. Most patients presented with obstructive lower urinary tract symptoms (64.5%) and strictures were proximal bulbar, i.e. just close to the external urethral sphincter, in 38.3%. The median (range) follow-up duration was 24 (8-127) months. In 60.1% patients did not require any further instrumentation, while RSD was maintained in 28.3%,patients. On multivariate analysis, older age at presentation [odds ratio (OR) 1.014; P = 0.02], obesity (OR 1.624; P = 0.013), and idiopathic strictures (OR 3.102; P = 0.035) were independent predictors of failure after DVIU. Conclusions:The failure rate after DVIU accounted for 39.9 % of our present study with older age at presentation, obesity, and idiopathic strictures independent predictors of failure after DVIU. This information is important in counselling patients before surgery.