Anterior urethral strictures

Aim

The aim of the present study was to determine the practice patterns in the management of anterior urethral strictures among urologists in Hong Kong.

Patients and Methods

A 14‐item questionnaire was delivered either directly or by mail to all 126 registered urologists in Hong Kong. Information including demographic data, number of anterior urethral strictures treated, diagnostic methods, treatment options and follow‐up strategy were collected. The questionnaire also asked for the personal opinion about the treatment plan of two stricture case scenarios.

Results

The response rate was 48 per cent. The majority (87 per cent) of urologists treated <10 anterior urethral strictures per year. Minimal invasive procedures, including urethral dilatation using metal sounds (77 per cent) or cystoscopy‐guided (74 per cent) and direct visual internal urethrotomy (57 per cent), were more commonly performed by urologists to treat urethral strictures. The majority of urologists (82.6 per cent) performed less than five urethroplasties per year. In the two case scenarios of long bulbous urethral stricture and recurrent short urethral stricture, approximately 10 per cent of respondents would refer the cases to other urologists and approximately 75 per cent would choose to perform reconstructive surgeries. The remaining 15 per cent of respondents would choose minimally‐invasive procedures for these strictures. Nearly two‐thirds (62.3 per cent) of urologists believed that urethroplasty should be proposed only after failed endoscopic treatment. Workups for urethral stricture disease were consistent, while the modalities to access the outcome were highly heterogeneous.

Conclusion

In Hong Kong, the majority of urologists choose to perform urethroplasty for long bulbous urethral strictures and recurrent short bulbous urethral strictures in a case scenario situation. However, in actual practice, most perform less than five urethroplasties per year. A small caseload, lack of experience and understanding of urethral reconstructive surgery means that most urologists in Hong Kong would hesitate to carry out primary urethroplasty in correctly‐selected patients for whom primary reconstruction would have been the treatment of choice.