Influence of Procedure Type on Time to Urethoplasty: A Retrospective Comparison of Urethral Dilatation and Direct Visual Internal Urethrotomy for Anterior Urethral Strictures

Background: Anterior urethral strictures are managed in various ways, and endoscopic treatment remains the most common, despite limited durability.Compared to definitive reconstruction, the evidence supporting the role of endoscopic techniques is vague regarding their influence on disease progression.Objective: This study aims to compare urethral dilatation and direct visual internal urethrotomy (DVIU) in terms of time to urethroplasty.Methods: This retrospective cohort analysis was conducted at Prince Hussein Urology and Organ Transplant Centre, King Hussein Medical Centre, Amman, Jordan, between 2020 and 2025.Adult patients with anterior urethral strictures treated with urethral dilatation (Group I) or DVIU (Group II) were included.Prior urethroplasty and incomplete follow-up were exclusion criteria.The primary outcome measure was time to urethroplasty, defined as the number of months between the index endoscopic procedure at our institution to treat urethral stricture and its first substitution urethroplasty (definitive urethral reconstruction in which a tissue graft or flap was used to augment or replace the diseased segment of the urethra).Patients were followed for a minimum of 12 months and censored at last follow-up if urethroplasty had not been performed.Survival analysis was performed using Kaplan-Meier methods with log-rank testing, and Cox proportional hazards regression was used to identify independent predictors.Results: A total of 193 patients were included, with 73 (37.8%) in Group I and 120 (62.2%) in Group II.Baseline characteristics were similar, but Group I had a higher proportion of patients with multiple prior endoscopic procedures (p=0.041).Idiopathic strictures were the most common etiology (47.2%).Urethroplasty was required in 31.5% of Group I and 25.8% of Group II patients (p=0.389).There was no difference in urethroplasty-free survival (log-rank p=0.403).In multivariable analysis, two or more prior endoscopic procedures were independently associated with shorter time to urethroplasty (adjusted HR 4.286, p<0.001).Conclusions: The frequency of previous endoscopic treatments, rather than the choice of initial technique, was strongly associated with progression to urethroplasty.Urethral dilatation and DVIU yielded comparable outcomes.