title: Is there a way to predict failure after direct vision internal urethrotomy for single and short bulbar urethral strictures?
abstract: OBJECTIVE
  To identify patient and stricture characteristics predicting failure after direct vision internal urethrotomy (DVIU) for single and short (<2 cm) bulbar urethral strictures.
  
  
  METHODS
  We retrospectively analysed the records of adult patients who underwent DVIU between January 2002 and 2013. The patients' demographics and stricture characteristics were analysed. The primary outcome was procedure failure, defined as the need for regular self-dilatation (RSD), redo DVIU or substitution urethroplasty. Predictors of failure were analysed.
  
  
  RESULTS
  In all, 430 adult patients with a mean (SD) age of 50 (15) years were included. The main causes of stricture were idiopathic followed by iatrogenic in 51.6% and 26.3% of patients, respectively. Most patients presented with obstructive lower urinary tract symptoms (68.9%) and strictures were proximal bulbar, i.e. just close to the external urethral sphincter, in 35.3%. The median (range) follow-up duration was 29 (3-132) months. In all, 250 (58.1%) patients did not require any further instrumentation, while RSD was maintained in 116 (27%) patients, including 28 (6.5%) who required a redo DVIU or urethroplasty. In 64 (6.5%) patients, a redo DVIU or urethroplasty was performed. On multivariate analysis, older age at presentation [odds ratio (OR) 1.017; P = 0.03], obesity (OR 1.664; P = 0.015), and idiopathic strictures (OR 3.107; P = 0.035) were independent predictors of failure after DVIU.
  
  
  CONCLUSIONS
  The failure rate after DVIU accounted for 41.8% of our present cohort with older age at presentation, obesity, and idiopathic strictures independent predictors of failure after DVIU. This information is important in counselling patients before surgery.
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Harraz
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Assmy
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Mahmoud
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Amr A
authors.initials: AA
authors.lastname: Elbakry
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tharwat
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Helmy
authors.initials: H
authors.lastname: Omar
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Hashim
authors.initials: H
authors.lastname: Farg
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Laymon
authors.affiliation: Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mosbah
keywords: BMI, body mass index; DVIU, direct vision internal urethrotomy; Direct vision internal urethrotomy; RSD, regular self-dilatation; RUG, retrograde urethrography; Recurrence; Urethral stricture; Urethroplasty