Internal urethrotomy versus dilation as treatment for male urethral strictures: A prospective, randomized comparison

Purpose: We compared the efficacy of dilation versus internal urethrotomy as initial outpatient treatment for male urethral stricture disease. Materials and Methods: A total of 210 men with proved urethral strictures was randomized to undergo filiform dilation (106) or optical internal urethrotomy (104) with local anesthesia on an outpatient basis. Results: Life table survival analysis showed no significant difference between the 2 treatments with regard to stricture recurrence. Hazard function analysis showed that the risk of stricture recurrence was greatest at 6 months, whereas the risk of failure after 12 months was slight. The recurrence rate at 12 months was approximately 40% for strictures shorter than 2 cm. and 80% for those longer than 4 cm., whereas the recurrence rate for strictures 2 to 4 cm. long increased from approximately 50% at 12 months to approximately 75% at 48 months. Cox regression analysis showed that for each 1 cm. increase in length of the stricture the risk of recurrence was increased by 1.22 (95% confidence interval 1.05 to 1.43). Conclusions: There is no significant difference in efficacy between dilation and internal urethrotomy as initial treatment for strictures. Both methods become less effective with increasing stricture length. We recommend dilation or internal urethrotomy for strictures shorter than 2 cm., primary urethroplasty for those longer than 4 cm. and a trial of dilation or urethrotomy for those 2 to 4 cm. long.