BACKGROUND: Adult anterior urethral stricture disease is most often treated with dilatation or direct vision internal urethrotomy (DVIU). Although evidence suggests that anastomotic urethroplasty for short bulbar strictures is more efficient and cost effective in the long term, no consensus exists. It is unclear by whom and how often urethroplasties are performed in The Netherlands and how results are being evaluated. OBJECTIVE: To determine national practice patterns on management of anterior urethral strictures among Dutch urologists. This information will help to define the nationwide need for training in urethral surgery. DESIGN, SETTING, AND PARTICIPANTS: We conducted a 16-question survey among all 323 Dutch urologists. RESULTS AND LIMITATIONS: The response rate was 74%. DVIU was practised by 97% of urologists. Urethroplasty was performed at least once yearly by 23%, with 6% performing more than five urethroplasties annually. In the group of urologists younger than 50 yr of age, 13% performed urethroplasty, with 3% of those performing more than five annually. In the case of a 3.5-cm-long bulbar stricture, DVIU was preferred by 49% of responders. Even after two recurrences, 20% continued to manage a 1-cm-long bulbar stricture endoscopically. Of responders, 79% believed that urethroplasty should be proposed only after a failed endoscopic attempt. Diagnostic workup and evaluation of success varied greatly. CONCLUSIONS: Most Dutch urologists believe that urethroplasty is an option only after failed DVIU. Endoscopic procedures are widely used, even when the risk of recurrence is virtually 100%. The definition of success is hampered by nonstandardised methods of follow-up. Only a small group of mainly older urologists frequently performs urethroplasties. Training programmes seem necessary to guarantee a high standard of care for stricture disease in The Netherlands. A pan-European practice survey might be interesting to clarify the need for centralised fellowship programmes.
BACKGROUND:Adult anterior urethral stricture disease is most often treated with dilatation or direct vision internal urethrotomy (DVIU). Although evidence suggests that anastomotic urethroplasty for short bulbar strictures is more efficient and cost effective in the long term, no consensus exists. It is unclear by whom and how often urethroplasties are performed in The Netherlands and how results are being evaluated. OBJECTIVE: To determine national practice patterns on management of anterior urethral strictures among Dutch urologists. This information will help to define the nationwide need for training in urethral surgery. DESIGN, SETTING, AND PARTICIPANTS: We conducted a 16-question survey among all 323 Dutch urologists. RESULTS AND LIMITATIONS: The response rate was 74%. DVIU was practised by 97% of urologists. Urethroplasty was performed at least once yearly by 23%, with 6% performing more than five urethroplasties annually. In the group of urologists younger than 50 yr of age, 13% performed urethroplasty, with 3% of those performing more than five annually. In the case of a 3.5-cm-long bulbar stricture, DVIU was preferred by 49% of responders. Even after two recurrences, 20% continued to manage a 1-cm-long bulbar stricture endoscopically. Of responders, 79% believed that urethroplasty should be proposed only after a failed endoscopic attempt. Diagnostic workup and evaluation of success varied greatly. CONCLUSIONS: Most Dutch urologists believe that urethroplasty is an option only after failed DVIU. Endoscopic procedures are widely used, even when the risk of recurrence is virtually 100%. The definition of success is hampered by nonstandardised methods of follow-up. Only a small group of mainly older urologists frequently performs urethroplasties. Training programmes seem necessary to guarantee a high standard of care for stricture disease in The Netherlands. A pan-European practice survey might be interesting to clarify the need for centralised fellowship programmes.
Authors: Luis A Kluth; Roland Dahlem; Andreas Becker; Marianne Schmid; Armin Soave; Clemens Rosenbaum; Tim A Ludwig; Natalie Christ; Michael Rink; Philip Reiss; Oliver Engel; Silke Riechardt; Felix K-H Chun; Margit Fisch; Sascha A Ahyai Journal: World J Urol Date: 2015-06-07 Impact factor: 4.226
Authors: Lindsay A Hampson; Tracy K Lin; Leslie Wilson; Isabel E Allen; Thomas W Gaither; Benjamin N Breyer Journal: World J Urol Date: 2017-06-29 Impact factor: 4.226
Authors: Robert Pickard; Beatriz Goulao; Sonya Carnell; Jing Shen; Graeme MacLennan; John Norrie; Matt Breckons; Luke Vale; Paul Whybrow; Tim Rapley; Rebecca Forbes; Stephanie Currer; Mark Forrest; Jennifer Wilkinson; Elaine McColl; Daniela Andrich; Stewart Barclay; Jonathan Cook; Anthony Mundy; James N'Dow; Stephen Payne; Nick Watkin Journal: Health Technol Assess Date: 2020-11 Impact factor: 4.014
Authors: Felix Campos-Juanatey; Enrique Fes-Ascanio; Jan Adamowicz; Fabio Castiglione; Andrea Cocci; Guglielmo Mantica; Clemens Rosenbaum; Wesley Verla; Malte W Vetterlein; Marjan Waterloos; Luis A Kluth Journal: J Clin Med Date: 2022-04-22 Impact factor: 4.241