Evaluation of Direct Visual Internal Urethrotomy in The Management of Anterior Urethral Strictures

Background: Male urethral stricture continues to be a common and challenging urologic condition. Despite the high failure rate of endoscopic urethrotomy, direct visual internal urethrotomy (DVIU) remains the most commonly performed procedure for the treatment of urethral strictures. It is an effective short-term treatment, but the long-term success rate is low. In this article, we reported the outcome of endoscopic management of anterior urethral stricture. Objective: The aim of the study was to evaluate the outcome of endoscopic urethrotomy. Study design: This is a prospective descriptive study in patients admitted to General Military Hospital (GMH) Sana’a in the period between Jan. 2023 to September. 2025. Patients and methods: Forty-two patients with anterior urethral stricture are included, whom underwent endoscopic urethrotomy The mean age of the patients is 41.5 years ranging between 19-72 years. All patients were evaluated by history, local and systemic physical examination, and radiological assessment according to each case. Results: Of 42 patients presented to the hospital, the most common etiology was iatrogenic (38.1%), followed by blunt trauma (31%), penetrating trauma (14.3%), idiopathic (9.5%), and inflammation (7.1%). The most common site of urethral stricture was bulbar (35.7%), followed by penile (28.6%), membranous (28.6%), and Pan-urethra (7.1%) of cases. The overall complication rate was 26.2%, with reccurnce of stricture (42.8%) being the most common. The only significant difference was observed in relation to stricture length and location. Conclusion: Endoscopic management is usually the first option for many cases of anterior urethral stricture, because of being simple, cost-effective and its repeatability. However, for strictures that are longer than 2 cm, and in patients whom multiple DVIU attempt failed reconstruction urethroplasy is advised.