Urethral stricture disease is an uncommon urologic disorder but carries significant morbidity.
Direct vision urethrotomy (DVIU) is the procedure of choice for most urethral strictures in the United States. DVIU is an inexpensive, outpatient procedure with few complications and success rates of 39% to 73% have been reported for short strictures. DVIU has a low long-term success rate for longer strictures. Urethroplasty is the reference standard, but it is a complex operation requiring hospitalization, and many patients undergo multiple DVIU's before urethroplasty is considered. Urethroplasty is indicated for long, densely fibrotic strictures, but debate exists as to the optimal management of short strictures of the bulbar urethra.
A recent study by J. L. Wright, Hunter Wessels and colleagues from the University of Washington in Seattle, examined the cost-effectiveness of the treatments for bulbar strictures between 1 and 2 cm. The study is published in the May, 2006 issue of Urology. A decision tree was constructed that applied the statistical technique of decision analysis which applies a systematic framework for decision making between competing options in the face of uncertainty.