Transurethral procedures, such as direct vision internal urethrotomy (DVIU) and urethral dilation, have traditionally been overused in the management of male anterior urethral stricture. The publication of urethral stricture management guidelines has encouraged a shift toward more appropriate treatment approaches. This study aimed to investigate whether intergenerational differences influence Japanese urologists’ experience and management patterns for anterior urethral stricture.

This survey was based on previous national surveys on anterior urethral stricture management and was adapted to reflect current Japanese clinical practice. The Japanese Urological Association (JUA) conducted an online survey from December 2023 to March 2024, targeting all JUA members. Respondents were stratified into two age groups: younger urologists (<50 years) and senior urologists (≥50 years). Comparisons were made between the two groups based on their experience and preferences in managing anterior urethral stricture.

Among the 9,898 JUA members, 1,028 (10.4%) responded to the survey, including 535 (52.0%) younger urologists and 493 (48.0%) senior urologists. More than 90% of both groups had experience with DVIU or urethral dilation. There was no significant difference in the proportion of respondents with experience in excision and primary anastomosis urethroplasty (27.3% vs. 33.1%, p = 0.0775). However, younger urologists were more likely to select urethroplasty as the initial treatment for longer bulbar strictures when indicated (79.4% vs. 70.8%, p = 0.00144). Additionally, younger urologists performed retrograde urethrography more frequently for pre-treatment evaluation (85.8% vs. 77.1%, p = 0.000376).

Despite having less experience in urethroplasty, younger urologists demonstrated a higher adherence to guideline-recommended management of anterior urethral stricture compared to senior urologists. These findings suggest that younger urologists may be more inclined to implement guideline-based recommendations in clinical practice.