Urethral stricture disease (USD) represents a common yet often overlooked urological condition characterized by the narrowing of the urethra, which can lead to various urinary symptoms and complications. The approach to urethral stricture management has mainly been guided by clinical practice guidelines provided by associations such as the European Association of Urology (EAU) and the American Urological Association (AUA). This study aims to compare current practices, challenges, and outcomes related to USD management in the Philippines among Filipino urologists, to further improve healthcare outcomes for individuals affected by this condition. This study also aims to evaluate the level of adherence to international standards in urethral stricture management.

This is a cross-sectional study using a survey questionnaire, formulated by the authors, based on common-practice studies performed in different various countries including the Philippines. The questionnaire was divided into the following points of interest for this study: (1) demographic profile, (2) clinical practice parameters, (3) diagnostic work up and disease management, (4) postoperative follow-up and defining success or failure of intervention.

Urologists from the 30-to-39-years old age group saw the most number of stricture cases, with 38% of its participants encountering >20 patients in one year. Also, the majority of respondents (17%) who have attended to >20 patients were urology residents-in-training. Majority (92%) of urologists perform retrograde urethrogram for USD cases. There were a lesser number of respondents who preferred using a KUB ultrasound as a diagnostic tool, and their number was roughly equal among all age groups of urologists. Majority of Filipino urologists (81.3%) will recommend urethral rest prior to definitive surgical management, and there was no note significant difference across all groups. Overall, among those who did encounter USD cases, majority of them did not perform urethroplasty for urethral strictures. For those who did perform urethroplasty, specifically buccal mucosal graft urethroplasty, 53% of them belonged to the 30-39 age group. A subset analysis showed a significant difference between urologists (urban versus rural) when asked about performing DVIU for a meatal or fossa navicularis stricture, with urologists practicing in the cities shown to be more likely to perform a DVIU for a stricture in those urethral segments. As for USD in other urethral segments, there was no significant difference between the number of urologists who would perform a DVIU instead of urethroplasty. This likely reflects the indiscriminate use of DVIU among Filipino urologists. Only 9.3% (n=10) of Filipino urologists were found to adhere to the EAU and AUA recommendations of leaving an indwelling catheter for only 2 to 5 days following surgery. Postoperatively, the results showed that only 57% (n=61) of Filipino urologists will not advise patients to perform intermittent self-catheterization following a DVIU. Moreover, the results show that 52.3% (n=56) of respondents performed a retrograde urethrogram +/- VCUG following urethroplasty, which was both in the EAU and AUA recommendation to assess postoperative outcomes. The EAU guidelines also suggest uroflowmetry +/- post-void residual and Internal Prostate Symptom Score (IPSS) after performing a DVIU. Sixty two (57.9%) and 56 (52.3%) Filipino urologists, respectively followed these recommendations. Finally, in terms of postoperative follow-up, our data shows that 43.6% (n=46) of respondents would follow the patient up to 1 year post-stricture surgery.

The AUA and EAU guidelines offer evidence-based recommendations for best clinical practice in patients with stricture disease. Though majority of Filipino urologists adhere to these recommendations, there are still some, especially those in the provinces and those who are not affiliated with training institutions, who have variations in their own private practices. Non-adherence to guidelines is often due to the lack of exposure to stricture cases in one’s area of practice. Despite these variations in practice, Filipino urologists do look to the guidelines for support and follow most of the recommendations, if not in their entirety.