A Comprehensive Comparative Study of Direct Vision Internal Urethrotomy and Urethroplasty in Short-Segment Bulbar Urethral Strictures

Background Currently, there is no data on the prevalence of urethral stricture illness in India. For short-segment bulbar urethral stricture, end-to-end anastomosis is the gold standard of care. The purpose of this study was to find where the direct vision internal urethrotomy (DVIU) exists in today's era. Also, it compared DVIUs with urethroplasty. Further, the comparison was performed in the urethroplasty group which was converted into two sub-groups; buccal mucosal graft (BMG) and anastomotic urethroplasty. Materials and methods It was a randomized prospective interventional study. The study was conducted at the Department of Urology at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India. The total duration of the study was one year and six months. Ethical approval for the conduction of the study has been obtained from the institutional ethics committee (IEC) of IGIMS, Patna, Bihar, India under letter number 840/IEC/IGIMS/2022 dated 10 December 2022. Results The study included two comparisons, one between urethrotomy and urethroplasty, that found significant differences in the International Prostate Symptom Score (IPSS) scores at three months. However, the IPSS scores were found to be insignificant between the groups at six months. Also, no statistically significant difference was observed in the International Prostate Symptom Score-Quality-of-Life (IPSS-QOL) between the two groups at three and six months. The statistically significant difference between them was observed in the maximum urinary flow rate (Qmax) and the International Index of Erectile Function-5 (IIEF-5) scores at three and six months, respectively. Another comparison was done between BMG and the excision and primary anastomosis (EPA) groups, where there was no statistical difference observed between the groups in terms of IPSS, IPSS-QOL, Qmax, and recurrence at three and six months. However, there was a statistical difference observed in IIEF-5 scores between the groups at three and six months, respectively. The mode of anaesthesia in the DVIU group was either total intravenous anaesthesia (TIVA) or spinal anaesthesia. On the other hand, all cases of BMG urethroplasty required general anaesthesia with nasal intubation and all cases of EPA required spinal anaesthesia. Conclusion It has been concluded that in today's era, DVIU can be considered for de-novo short-segment bulbar urethral stricture in individuals who are concerned about sexual life. And, for short-segment bulbar urethral stricture less than 2 cm, BMG is a better alternative to EPA as it is associated with less erectile dysfunction. A decrease in erectile function is more common in anastomotic urethroplasty as compared to BMG urethroplasty. Further studies comparing muscle sparing, nerve sparing, and vessel sparing are required to address this problem.