Management of bulbar urethral strictures by direct vision internal urethrotomy: Experience from a Nigerian teaching hospital

Background: Urethral stricture is a common cause of bladder outflow obstruction, and its management contributes significantly to the workload in urologic practice. Aim(s): To evaluate the role of direct vision internal urethrotomy (DVIU) in the management of bulbar urethral strictures. Methods: A retrospective review done at a University Teaching Hospital in Nigeria. Patients who had DVIU for the management of bulbar urethral strictures between July 2008 and June 2015 were studied. Information extracted and analysed were the patients' age, stricture characteristics, DVIU technique, outcome and complications. Statistical Package for Social Sciences version 20 was used for data analysis. Results: A total of 63 patients had DVIU for bulbar urethral strictures during the period, of which 48 patients (76.2%) were studied. Their ages ranged between 32 and 70 years (mean 49 years). They all had solitary, short-segment, incomplete, bulbar urethral strictures confirmed pre-operatively by retrograde urethrogram. In addition, 36 (75%) also had urethrosonography which confirmed superficial spongiofibrosis. In 28 cases (58%), stricture aetiology was post-inflammatory, while in 12 (25%) and 8 (17%) patients, strictures were due to iatrogenic reasons (post-catheterisation) and straddle injuries, respectively. The DVIU was done by the same group of surgeons. Success rate was 66.7% after first DVIU and increased to 75.0% after a second DVIU was done for those with unsatisfactory outcome after first surgery. Mean follow-up period was 15 months. Conclusion: In well-selected patients, DVIU is an option for successful treatment of bulbar urethral strictures.