Management of urethral strictures: A nationwide survey of urologists in the Kingdom of Saudi Arabia

Context: urethral strictures commonly occur and considered difficult to manage due to high recurrence rate and wide variety of management approach.

Aims: This study aims to identify how urologists in Saudi Arabia manage new and recurrent urethral stricture cases and to investigate their opinions regarding urethroplasty.

Settings and design: A cross-sectional study (Online Survey) among urologists.

Subjects and methods: A nationwide survey of urologists registered with the Saudi Commission for Health Specialties was performed through a mailed questionnaire. A total of 603 urologists were selected from all five regions of Saudi Arabia, of whom 216 (35.8%) completed the questionnaire.

Statistical analysis used: SPSS software version 23 was used for data entry and analysis.

Results: Most urologists (40.3%) had treated 1-5 urethral strictures in the past year. The most common procedures used to manage urethral strictures were visual urethrotomy (82.4%), cystoscopy and dilatation (62.2%), and excision and primary anastomosis (20.8%). Minimally invasive procedures were used more frequently than any open urethroplasty techniques. Most urologists (63%) did not perform urethroplasty surgery, and 21.8% were not aware of any adult reconstructive urologists in Saudi Arabia. When used, however, the most commonly performed urethroplasty surgeries were excision and primary anastomosis, dorsal buccal graft augmented urethroplasty, and ventral buccal graft augmented urethroplasty.

Conclusions: Minimally invasive methods are easy to perform and have good short-term outcomes. As such, they are more commonly used for the management of urethral strictures. On the other hand, urethroplasty surgeries are challenging procedures that require greater experience and skill.