title: [The efficacy of direct vision internal urethrotomy for male urethral stricture].
abstract: OBJECTIVE
  Direct vision internal urethrotomy (DVIU) has been considered to be a low invasive and widely used therapeutic modality for male urethral stricture. However, its efficacy is still controversial. We herein evaluated the efficacy of DVIU for male urethral stricture.
  
  
  METHODS
  Nineteen patients 27 to 78 years old (median age = 59) underwent DVIU for urethral strictures at our hospital were included in this study. Strictures were at bulbar urethra in 17 patients, membranous urethra in 1 patient, and pendulous urethra in 1 patient. The stricture lengths estimated on retrograde urethrography were less than 1 cm in 13 patients, 1-2 cm in 2 patients, and more than 2 cm in 4 patients. The etiology of stricture was straddle injury in 7 patients, post transurethral surgery in 7 patients, pelvic fracture in 1 patient, and unknown in 4 patients. The operation was done by cold knife incision using guidewire. The duration of postoperative urethral catheterization was 5 to 35 days (mean 12.8 days). Follow up duration ranged from 1 month to 139 months (mean 48.2 months). The definition of postoperative re-stricture was the confirmation of re-stricture on retrograde urethrography or deterioration of symptom.
  
  
  RESULTS
  While no severe complication was observed, postoperative re-stricture was seen in 13 patients. Stricture-free rates at 3 months, 6 months, and 5 years after the first DVIU were 44.4%, 38.1%, 20.3% respectively. Although second DVIU was done for 7 patients with re-stricture, six patients resulted in failure. Stricture-free rates at 3 months, 6 months, and 5 years after the second DVIU were 42.2%, 28.6%, 14.3% respectively. Though the third DVIU was done for two of them, they were unable to void just immediately after the removal of urethral catheters. Stricture-free rate in stricture less than 1 cm was higher than that in 1 cm or longer, though it did not reach significant difference (p = 0.1813).
  
  
  CONCLUSIONS
  The efficacy of DVIU is lesser than we expected. DVIU seems to be excessively applied to male urethral strictures and should not be performed for long and recurrent urethral stricture.
authors.affiliation: Department of Urology, National Defense Medical College, Saitama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Isono
authors.forename: Akio
authors.initials: A
authors.lastname: Horiguchi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Tasaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroda
authors.forename: Akinori
authors.initials: A
authors.lastname: Sato
authors.forename: Junichi
authors.initials: J
authors.lastname: Asakuma
authors.forename: Kenji
authors.initials: K
authors.lastname: Seguchi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Asano
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods