Direct Vision Internal Urethrotomy (DVIU) is the most common management for patients with urethral stricture disease (USD) in the Philippines, owing to its ease of performance and short convalescence. This study aims to show the success rate of DVIU in the treatment of male urethral strictures in the local setting and, can be an index study that could be a basis for future management of urethral stricture disease in the Philippines.

A retrospective review was done from January 1995 to September 2024 on patients who underwent DVIU. Patients who underwent radiation therapy, with a history of previous open urethral surgery (e.g. urethroplasty and hypospadias repair), and those who were diagnosed with bladder neck contracture, were excluded from the study. The stricture-free rate following the first to third DVIU procedures was analyzed using the Kaplan-Meier method.

138 patients were included in the analysis, wherein the stricture-free rate was noted to be 21.7% (n = 30). The mean time to recurrence was 16 months, ranging from 3 weeks to 96 months, after the first DVIU. 38 patients (28%) had a second DVIU, with stricture-free rates of 0% with a mean time to recurrence of 21 months, ranging from 2 weeks to 120 months. 12 patients (8%) underwent a third DVIU with 0% stricture-free rates, with a 14-month mean time to recurrence, with a range of 1 week to 36 months. The initial mean stricture length was 1.8 cm (0.5 - 7.5cm) and the mean stricture length at the time of recurrence, post-first DVIU, was 3cm (1.5 - 8cm) which was statistically significant (p <0.001). A total of 58 patients had early recurrence. In patients with strictures >2cm in length, 70% (39 patients) had early recurrence, in contrast to patients with <2cm, only 29% recurred within 12 months (P = 0.005). 25 patients had penile urethral strictures. 50% (n = 12) of which had early recurrence. Of note is that the single instance of urethral diverticulum, and 2 out of the 4 urethrocutaneous fistula were found in this subgroup.

In the local setting, the overall success rate of direct vision internal urethrotomy is poor for patients with USD. The stricture stricture-free rate of an initial DVIU is only 21.7%, while subsequent DVIUs demonstrated a 100% stricture recurrence rate. DVIUs performed for strictures >2cm and located in the penile urethra are observed to have more complications and early recurrences. Furthermore, recurrences after DVIU are longer and more complex than the initial presentation. Urethroplasty might be a more valid option for USD with DVIU as a temporary measure before definitive treatment. To our knowledge, this is the first such study in the Philippines to describe DVIU success rates over medium-term follow-up.