INTERNAL URETHROTOMY VERSUS DILATION AS TREATMENT FOR MALE URETHRAL STRICTURES - A PROSPECTIVE, RANDOMIZED COMPARISON

Purpose: We compared the efficacy of dilation versus internal urethrot omy as initial outpatient treatment for male urethral stricture diseas e. Materials and Methods: A total of 210 men with proved urethral stri ctures was randomized to undergo filiform dilation (106) or optical in ternal urethrotomy (104) with local anesthesia on an outpatient basis. Results: Life table survival analysis showed no significant differenc e between the 2 treatments with regard to stricture recurrence. Hazard function analysis showed that the risk of stricture recurrence was gr eatest at 6 months, whereas the risk of failure after 12 months was sl ight. The recurrence rate at 12 months was approximately 40% for stric tures 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 appr oximately 50% at 12 months to approximately 75% at 48 months. Cox regr ession analysis showed that for each 1 cm. increase in length of the s tricture the risk of recurrence was increased by 1.22 (95% confidence interval 1.05 to 1.43). Conclusions: There is no significant differenc e in efficacy between dilation and internal urethrotomy as initial tre atment for strictures. Both methods become less effective with increas ing stricture length. We recommend dilation or internal urethrotomy fo r strictures shorter than 2 cm., primary urethroplasty for those longe r than 4 cm. and a trial of dilation or urethrotomy for those 2 to 4 c m. long.