title: Management of adult anterior urethral stricture disease: nationwide survey among urologists in the Netherlands.
abstract: BACKGROUND
  Adult anterior urethral stricture disease is most often treated with dilatation or direct vision internal urethrotomy (DVIU). Although evidence suggests that anastomotic urethroplasty for short bulbar strictures is more efficient and cost effective in the long term, no consensus exists. It is unclear by whom and how often urethroplasties are performed in The Netherlands and how results are being evaluated.
  
  
  OBJECTIVE
  To determine national practice patterns on management of anterior urethral strictures among Dutch urologists. This information will help to define the nationwide need for training in urethral surgery.
  
  
  METHODS
  We conducted a 16-question survey among all 323 Dutch urologists.
  
  
  CONCLUSIONS
  The response rate was 74%. DVIU was practised by 97% of urologists. Urethroplasty was performed at least once yearly by 23%, with 6% performing more than five urethroplasties annually. In the group of urologists younger than 50 yr of age, 13% performed urethroplasty, with 3% of those performing more than five annually. In the case of a 3.5-cm-long bulbar stricture, DVIU was preferred by 49% of responders. Even after two recurrences, 20% continued to manage a 1-cm-long bulbar stricture endoscopically. Of responders, 79% believed that urethroplasty should be proposed only after a failed endoscopic attempt. Diagnostic workup and evaluation of success varied greatly.
  
  
  CONCLUSIONS
  Most Dutch urologists believe that urethroplasty is an option only after failed DVIU. Endoscopic procedures are widely used, even when the risk of recurrence is virtually 100%. The definition of success is hampered by nonstandardised methods of follow-up. Only a small group of mainly older urologists frequently performs urethroplasties. Training programmes seem necessary to guarantee a high standard of care for stricture disease in The Netherlands. A pan-European practice survey might be interesting to clarify the need for centralised fellowship programmes.
authors: Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands. m.a.vanleeuwen@umcutrecht.nl
authors: Menno A
authors: MA
authors: van Leeuwen
authors: Jacob J
authors: JJ
authors: Brandenburg
authors: Esther T
authors: ET
authors: Kok
authors: Peter L M
authors: PL
authors: Vijverberg
authors: J L H Ruud
authors: JL
authors: Bosch
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014525:Urethral Stricture / Q000601:surgery*; D014572:Urology