Materiały źródłowe

• #1 Epidemiology of urethral strictures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4708169/

  Urethral stricture disease is relatively common and is associated with a significant financial cost and potentially debilitating outcomes. Understanding urethral stricture epidemiology is important to identify risk factors associated with the etiology or progression of the disease. This understanding may lead to better treatments and preventative measures that could ameliorate disease severity, produce better health outcomes, and reduce expenditures. […] Understanding the epidemiology of urethral strictures helps to identify risk factors for disease occurrence or progression, which may be amenable to preventive measures resulting in reduced disease severity and health care expenditure. This article provides a comprehensive review of the epidemiology of urethral stricture disease including incidence and prevalence, etiology, and epidemiology.

• #2 Epidemiology of urethral strictures – Alwaal – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/3755/html

  Urethral stricture disease is relatively common and is associated with a significant financial cost and potentially debilitating outcomes. Understanding urethral stricture epidemiology is important to identify risk factors associated with the etiology or progression of the disease. This understanding may lead to better treatments and preventative measures that could ameliorate disease severity, produce better health outcomes, and reduce expenditures. […] Understanding the epidemiology of urethral strictures helps to identify risk factors for disease occurrence or progression, which may be amenable to preventive measures resulting in reduced disease severity and health care expenditure. This article provides a comprehensive review of the epidemiology of urethral stricture disease including incidence and prevalence, etiology, and epidemiology.

• #3 Epidemiology of urethral strictures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4708169/

  Urethral stricture is a relatively common disease in men with an associated prevalence of 229-627 per 100,000 males, or 0.6% of the at risk population, who are typically older men. […] Santucci et al. analyzed urethral stricture disease in ten public and private data sets in the United States. They concluded that urethral stricture disease is common in the elderly population with a marked increase after 55 years of age. […] Data from Medicare and Medicaid Services (for patients older than 65 years) confirmed an increased incidence of stricture disease at 9.0/100,000 for 2001 compared to 5.8/100,000 in patients younger than 65 years. […] Patients with urethral stricture are considered a vulnerable population as they experienced high rates of UTIs (41%) and incontinence (11%) as sequelae of the disease.

• #4 Epidemiology of urethral strictures – Alwaal – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/3755/html

  Urethral stricture is a relatively common disease in men with an associated prevalence of 229-627 per 100,000 males, or 0.6% of the at risk population, who are typically older men. […] Santucci et al. analyzed urethral stricture disease in ten public and private data sets in the United States. They concluded that urethral stricture disease is common in the elderly population with a marked increase after 55 years of age. […] Data from Medicare and Medicaid Services confirmed an increased incidence of stricture disease at 9.0/100,000 for 2001 compared to 5.8/100,000 in patients younger than 65 years. […] Patients with urethral stricture are considered a vulnerable population as they experienced high rates of UTIs (41%) and incontinence (11%) as sequelae of the disease. […] However, multiple data sets they examined suggest that the rate of urethral stricture hospitalization and treatments decreased with time potentially due to a hypothetically decreased incidence/prevalence of the disease and/or increased success of strictures treatment.

• #5 Urethral Strictures in Males: Practice Essentials, Relevant Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/450903-overview

  The annual incidence rate of narrowing of the urethra is estimated to be from 200 to 1200 cases per 100,000 population, with dramatically higher rates in persons older than 55 years. The prevalence of urethral stricture in industrial countries is estimated at around 0.9%. […] Approximately 30% of urethral strictures are idiopathic. […] Iatrogenic urethral trauma usually results from improper or prolonged catheterization and accounts for 32% of strictures. […] Urethral stricture after radiation therapy for prostate cancer is a late complication usually observed 13 years after radiation. The overall reported incidence of urethral stricture after radiation therapy for prostate cancer varies from 0% to 18%.

• #6 Prevalent Practices in Male Anterior Urethral Stricture Management: A Survey

  https://openurologyandnephrologyjournal.com/VOLUME/15/ELOCATOR/e1874303X2203240/

  This article aimed to study the prevalent practices in the treatment and follow-up of urethral strictures. Moreover, the article aimed to investigate the present opinion among urologists as the treatment practices for urethral stricture disease are mostly dependent on the treating surgeons expertise and preference in the absence of widely followed standard guidelines. […] Urethral stricture is a common disease that has an estimated incidence of about 2001,200 cases per 100,000 male population, with the incidence being much higher in people aged 55 years. […] This survey on urethral stricture management amongst urologists shows that there is wide variation in the management of stricture urethra. This survey underscores the need for large-scale, long-term studies to formulate a guideline for the management of urethral stricture disease, thereby bringing uniformity in the care provided.

• #7 Urethral Strictures | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30833

  Urethral strictures are common, with a prevalence of 200/100,000 in younger men and more than 600/100,000 in men older than 65 in the United States. […] Urethral strictures are more common in older individuals and Black patients compared to the general population. There is a marked increase in incidence starting at 55. […] The estimated annual incidence rate in the United States is 0.9%. […] Male urethral strictures account for 5000 hospital admissions and 1.5 million clinic visits annually. […] In The United Kingdom, the prevalence is considerably less, estimated at 40/100,000 in men younger than 65 and 100/100,000 in men older than 65. […] Worldwide, the prevalence of male urethral strictures is estimated to range from 229 to 627/100,000.

• #8 Urethral Strictures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564297/

  Urethral strictures are common, with a prevalence of 200/100,000 in younger men and more than 600/100,000 in men older than 65 in the United States. Urethral strictures are more common in older individuals and Black patients compared to the general population. There is a marked increase in incidence starting at 55. The estimated annual incidence rate in the United States is 0.9%. […] Male urethral strictures account for 5000 hospital admissions and 1.5 million clinic visits annually. In The United Kingdom, the prevalence is considerably less, estimated at 40/100,000 in men younger than 65 and 100/100,000 in men older than 65. […] Worldwide, the prevalence of male urethral strictures is estimated to range from 229 to 627/100,000.

• #9 Epidemiology of urethral strictures – Alwaal – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/3755/html

  Some of the data sets indicate that Black Americans are at a higher risk of urethral stricture disease than White Americans. […] In addition, Santucci et al. demonstrated the high health care cost for treatment of urethral stricture disease. The total annual expenditure for stricture disease was 191 million dollars in 2000 with 69% of costs paid for ambulatory surgery visits. […] The urethral stricture rate after external beam radiation therapy is known to be low with a reported rate of 2%.

• #10 Male Urethral Stricture Disease | RAND

  https://www.rand.org/pubs/external_publications/EP20070534.html

  PURPOSE: The incidence of urethral stricture disease in the United States is unknown. The authors estimated the impact of urethral stricture disease by determining its prevalence, costs and other measures of burden, including side effects and the need for surgical intervention. […] RESULTS: Male urethral stricture disease occurred at a rate as high as 0.6% in some susceptible populations and resulted in more than 5,000 inpatient visits yearly. Yearly office visits for urethral stricture numbered almost 1.5 million between 1992 and 2000. The total cost of urethral stricture diseases in 2000 was almost $200 million, not including medication costs. A diagnosis of urethral stricture increased health care expenditures by more than $6,000 per individual yearly in insured populations after controlling for comorbidities. Urethral stricture disease appeared to be more common in the elderly population and in black patients, as measured by health care use. […] CONCLUSIONS: Despite decreasing rates of urethral strictures with time the burden of urethral stricture disease is still significant, resulting in hundreds of millions of dollars spent and hundreds of thousands of caregiver visits yearly.

• #11 EAU Guidelines on Urethral Strictures – Uroweb

  https://uroweb.org/guidelines/urethral-strictures/chapter/definition-epidemiology-aetiology-and-prevention

  In males, a sharp increase in incidence is observed after the age of 55 years, with a mean age of 45.1. […] Overall, the incidence is estimated to be 229-627 per 100,000 males. The anterior urethra is most frequently affected (92.2%), in particular the bulbar urethra (46.9%). […] In females, 2-29% of patients presenting with refractory lower urinary tract symptoms (LUTS) have bladder outflow obstruction (BOO) of whom 4-20% will have a urethral stricture. True FUS therefore occurs in 0.08-5.4% of women with refractory LUTS. There is a markedly increased incidence in women over 64 years of age. […] After hypospadias repair, meatal stenosis and urethral strictures are reported in 1.3-20% of cases, depending on the severity of the hypospadias and the technique used. […] Up to 18% of all urethral strictures have been reported to involve the meatus or fossa navicularis, usually due to failed hypospadias repair (FHR), lichen sclerosus (LS), trauma/instrumentation or idiopathic causes. […] In female-to-male (FtM) transgender patients (transmen), 2-56% will suffer a urethral stricture. Strictures almost exclusively arise at the neomeatus in male-to-female (MtF) transgender patients (transwomen) and occur in 4-40% of cases.

• #12 Management of Anterior Urethral Strictures – European Medical Journal

  https://www.emjreviews.com/urology/article/management-of-anterior-urethral-strictures/

  Urethral stricture disease (USD) affects 0.6% of the at-risk male population. Patients present with symptoms such as difficulty in voiding, nocturia, and painful urination, resulting in significantly reduced quality of life. The underlying causes and rates of incidence depend on patient age, race, geography, and socioeconomic status. Incidence varies based on age, race, geography, and socioeconomic status. The incidence is 1.6 and 10-times higher in older versus younger patients in the USA and UK, respectively. Beyond the age of 65 years, incidence steadily increases, peaking with men 85 years old. In the USA, African-Americans and Hispanics have a higher incidence of urethral strictures in comparison with Caucasians. Urethral strictures are 2.6-times more prevalent in urban centres than in rural ones. In developing countries, the prevalence of urethral strictures is thought to be much higher because of higher rates of infectious and inflammatory strictures, and they typically affect a much younger population. […] The real incidence of urethral strictures is not known, but estimates can be obtained from representative population datasets.

• #13 Urethral Stricture – AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/urethral-stricture-guideline

  Geographic setting, socioeconomic factors, and access to healthcare can affect stricture etiology. In high income countries, the most common etiology of urethral stricture is idiopathic (41%) followed by iatrogenic (35%). Late failure of hypospadias surgery and stricture resultant from endoscopic manipulation (e.g., transurethral resection) are common iatrogenic reasons. In comparison, trauma (36%) is the most common cause in low- and middle-income countries, reflecting higher rates of road traffic injuries, less developed trauma systems, inadequate roadway systems, and conceivably socioeconomic factors leading to a higher prevalence of trauma-related strictures. […] Strictures in the bulbar urethra are more common than other anatomic locations in males; however, certain etiologies are closely associated with an anatomic segment of the urethra. For example, strictures related to hypospadias and lichen sclerosus ([LS]; previously termed balanitis xerotica obliterans) are generally located in the penile urethra, while traumatic strictures and stenoses tend to be located in the bulbar and posterior urethra.

• #14 Urethral Stricture Diagnosis & Treatment | Mount Sinai – New York

  https://www.mountsinai.org/care/urology/services/reconstructive-urology/urethral-strictures

  If you experience unusual urinary symptoms or have difficulty urinating, you may have a urethral stricture. […] A urethral stricture can cause a very slow urinary stream or make it difficult to completely empty your bladder. […] Over time, a urethral stricture can cause permanent bladder damage, recurrent urinary tract infections (UTIs), blood in the urine, backup of urine in the kidneys, or kidney damage. […] Often, a urethral stricture results from trauma either from an injury such as a car or bike accident or complications from a medical procedure such as a urethral catheter placement, radiation treatment, or prostate surgery. […] There are several treatment options for a urethral stricture, depending on how large the blockage is and how much scar tissue you have. […] Treatment options for a urethral stricture include: Active surveillance, which means closely monitoring the stricture. […] Female Urethral Strictures […] Although less common, women can also have urethral strictures and our urologists are internationally recognized as experts in treating this problem. […] For these recurrent strictures, local skin from around the vagina can be used to reconstruct the urethra.

• #15 A Critical Overview of Urethral Complications in Transmasculine Surgery – American Urological Association

  https://auanews.net/issues/articles/2021/april-2021/a-critical-overview-of-urethral-complications-in-transmasculine-surgery

  Transmasculine genital reconstructive surgeries (TMGRS) are often performed with urethral lengthening (UL) to allow for micturition through a glanular meatus. […] Despite increasing numbers of TMGRS with UL being performed across multiple centers, the true rate of urethral complications remains unknown due to a lack of standard nomenclature, heterogeneous reporting, varying surgical techniques and a paucity of prospective, multi-institutional outcomes data. […] Strictures in metoidioplasty occur in about 25% of patients. […] Staged or single stage phalloplasty strictures occur 25% to 58% of the time. […] Strictures almost always require surgical intervention. […] The variability in TMGRS-UL techniques, the heterogeneity in reported urethral complications and the practice of only reporting complications that require surgical intervention cloud the interpretation of existing data.

• #16 Urethral Stricture Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/adult-urology/urethral-stricture-disease

  Men are more likely to have a urethral disease or injury because of their longer urethra. For this reason, strictures are more common in men. They are rare in women and in infants. […] In adults, urethral strictures are most often due to: injury from a fall onto the scrotum or perineum, prostate surgery, kidney stone removal, urinary catheterization, other surgical tools. […] Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can’t pass urine), which could lead to an enlarged bladder and kidney problems. […] Because urethral strictures can come back after surgery, you should be followed by a urologist. After the catheter is removed, your doctor will want to check you with physical exams and X-rays as needed. Sometimes the doctor performs urethroscopy to check the repair. In some patients, the stricture may return but may not need additional treatment. But if it causes obstruction, it can be treated with urethrotomy or dilation. Repeat open surgery may be needed for serious strictures that come back.

• #17 Medical Student Curriculum: Urethral Strictures – American Urological Association

  https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/urethral-strictures

  Complications of untreated urethral stricture disease can develop as a result of structural and functional changes to the urinary bladder and proximal urethra. […] Urethral strictures warrant prompt intervention with endoscopic approaches, urethroplasty, or perineal urethrostomy to prevent significant, potentially life-threatening complications.

• #18 Epidemiology of urethral strictures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4708169/

  However, multiple data sets they examined suggest that the rate of urethral stricture hospitalization and treatments decreased with time potentially due to a hypothetically decreased incidence/prevalence of the disease and/or increased success of strictures treatment. […] Some of the data sets indicate that Black Americans are at a higher risk of urethral stricture disease than White Americans, with sample numbers too low to draw accurate conclusions for Asian, Hispanic, and Native American patients. […] In addition, Santucci et al. demonstrated the high health care cost for treatment of urethral stricture disease. The total annual expenditure for stricture disease was 191 million dollars in 2000 with 69% of costs paid for ambulatory surgery visits. […] Urethral stricture disease is relatively common, and in many instances debilitating. The etiology of urethral stricture disease varies geographically. In general, the incidence of infection-related urethral stricture has decreased, especially in the developed world. In this review we examined the available incidence and prevalence data for urethral stricture disease. Further research is required to better delineate etiology of urethral strictures. Nearly a third of urethral stricture cases are idiopathic. Identifying cause in these cases may help to identify treatment options that could prevent disease development. Also, it is important to identify factors that could diminish iatrogenic causes. Lastly, better understanding and medical treatment of LS would lead to better control of its subsequent development and recurrence of strictures.

• #19

  https://journals.lww.com/cmii/fulltext/2019/17040/a_review_of_the_epidemiology_and_management_of.6.aspx

  The prevalence of urethral stricture in Sub-Saharan Africa is unknown though a few epidemiological studies show that it constitutes a huge disease burden in the region. […] There are, similar to the global situation, temporal and regional variations in the epidemiology of urethral stricture disease in Sub-Saharan Africa. […] The incidence has been documented to increase with age in the developed world where many of the strictures now result from medical intervention. […] There is a paucity of data on the epidemiology of urethral stricture disease in Sub-Saharan Africa. […] The implication is that urethral stricture constitutes a huge disease burden in the region. […] A mixed picture of predominant etiology obtains in this part of the world. […] Trauma remains a formidable etiology of urethral stricture.

• #20 Etiology, Epidemiology, Demographic Differences in Urethral Strictures: A Worldwide Perspective | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-21447-0_3

  The true incidence of urethral stricture disease remains globally unknown despite the great evolution in management over the last century. […] This could be attributed to the numerous publications on the etiology of urethral strictures.

• #21 Urethral Stricture

  http://www.urocenterofnewyork.com/our-research/urethral-strictures/

  The rate of visits to physician offices for urethral stricture disease in men ranges from 229 to 312/100,000 visits. […] Currently there is no widely accepted staging system for anterior urethral strictures. […] The absence of a staging system limits precision and concision in clinical discussions describing urethral strictures due to the lack of a common lexicon. […] Strictures can be subjectively described as dense, complete, partial, wide caliber or pinpoint tight. […] Currently, strictures are effectively staged with an ad hoc binary classification system in practice and in the literature with patients described as either having a stricture or not. […] We believe it would be more appropriate and more useful to describe strictures in a graded or staged fashion, particularly for general urologists making referrals for patients with stricture.

• #22 Urethral Stricture

  http://www.urocenterofnewyork.com/our-research/urethral-strictures/

  The use of nonstandardized outcome measures likely has a significant impact on the reported success of procedures to treat urethral strictures. […] The staging system may clarify why strictures become symptomatic. […] The use of this staging system may help better elucidate the natural history of urethral strictures. […] The classification scheme presents a framework for research charting the progression of these strictures and could define whether there is a pattern as well as the time to such progression. […] This simple cystoscopic system provides a common lexicon for outcomes research among different treatments for stricture disease. […] The application and relationship of this system to symptoms, type of repair used and surgical outcomes will be part of future evaluations.

• #23 Urethral Stricture – AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/urethral-stricture-guideline

  The clinical guideline on urethral stricture provides a clinical framework for the diagnosis of urethral stricture and includes discussion of initial management, urethroplasty, reconstruction, contracture, stenosis, special circumstances, and post-operative follow-up care. […] Clinicians should include urethral stricture in the differential diagnosis of patients who present with decreased urinary stream, incomplete emptying, dysuria, urinary tract infection, and after rising post-void residual. (Moderate Recommendation; Evidence Level: Grade C) […] After performing a history, physical examination, and urinalysis, clinicians may use a combination of patient reported measures, uroflowmetry, and ultrasound post-void residual assessment in the initial evaluation of suspected urethral stricture. (Clinical Principle)

• #24 Urethral Stricture – AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/urethral-stricture-guideline

  Clinicians should use urethro-cystoscopy, retrograde urethrography, voiding cystourethrography, or ultrasound urethrography to make a diagnosis of urethral stricture. (Moderate Recommendation; Evidence Level: Grade C) […] Surgeons may utilize urethral endoscopic management (e.g., urethral dilation, direct visual internal urethrotomy) or immediate suprapubic cystostomy for urgent management of urethral stricture, such as discovery of symptomatic urinary retention or need for catheterization prior to another surgical procedure. (Expert Opinion) […] Surgeons may place a suprapubic cystostomy to promote urethral rest prior to definitive urethroplasty in patients dependent on an indwelling urethral catheter or intermittent self-dilation. (Conditional Recommendation; Evidence Level: Grade C) […] Urethral stricture remains a subject of active investigation. The Panel suggests the following issues in future investigations: Basic science and epidemiological research into the etiology of urethral strictures.

• #25

  https://www.ijsurgery.com/index.php/isj/article/view/119

  Maximum 24% of the cases were in the age group of 31 to 40 years followed by age group 41 to 50 years (20%). […] Urethrography was the main method employed for diagnosis of stricture urethra in maximum cases. […] Various types of complications are associated with urethral stricture and is quite troublesome disease for the patients. […] The surgeon should be familiar with the various techniques in the management of the urethral stricture disease and the treatment should be individualized, taking into account of the location, extent and length of the stricture. […] Epidemiology of urethral stricture at Tygerberg Hospital. South African Medical Journal. 1994;84(5):267-8.

• #26

  https://www.ijcmph.com/index.php/ijcmph/article/view/8332

  Urethral strictures can significantly impact the quality of life for patients because it can be associated with significant complications such as fistulas, bladder calculi, infections and sepsis. […] The worldwide prevalence of urethral strictures is high, with an estimated rate of 229-627 patients per 100,000 population. […] Recurrence rates are reported after management with almost all of the current management modalities, indicating the need for better interventions to enhance the outcomes and alleviate the quality of care. […] The recurrence rate of strictures after treatment with internal urethrotomy and direct vision internal urethrotomy by three years is 65%. […] Other studies reported that the rate of recurrence was estimated to be around 14 after 6 months from internal urethrotomy and up to 27% after 12 months. […] The rate of complications and recurrence following treatment with anastomotic urethroplasty was estimated to be less than 5%.

• #27 Treatment for Urethral Stricture

  http://www.urocenterofnewyork.com/for-men/urethral-strictures/treatment-for-urethral-stricture/

  The treatment options for a urethral stricture include: […] Watching and closely monitoring the stricture called active surveillance […] For patients who have light, filmy, short strictures without a lot of scar tissue in the urethral sponge (called spongiofibrosis) active surveillance, urethral dilation or a endoscopic incision of the urethra may be an option. […] Because data has definitively shown that it provides the best long-term cure rates for patients with urethral strictures. […] Most urologists are not comfortable, experienced, or trained to do complex urethral reconstructive surgery and fall back on the easier, quicker option of dilation or incising the stricture. […] After one failed dilation or incision, there is nearly a 100% recurrence rate that means that almost all dilations after a stricture recurrence fail to last. […] UroLume was popular about a decade ago and has fallen out of favor among many urologists who are knowledgeable about stricture disease. […] The urologists at the Uro Center in New York are experts in their field, bringing academic and research based innovation to the clinical forefront.

• #28 The Epidemiology, Clinical Presentation, and Economic Burden of Urethral Stricture | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-7708-2_7

  Urethral stricture is a relatively common urologic problem associated with a significant economic burden. The prevalence of urethral stricture is estimated to range from 1 to 9 strictures per 1,000 people. The prevalence is highest and economic impact greatest in developing countries. Risk factors for urethral stricture include advanced age, sexually transmitted illness, socioeconomic status, race, lichen sclerosus, and a history of prostate cancer treatment. […] Urethral stricture not only adversely impacts patient-reported quality of life but also impacts overall health status. […] The optimal treatment of urethral stricture from a fiscal standpoint depends on several factors. In non-industrialized nations with a lack of medical infrastructure and expertise, optimizing the use of endoscopic treatment may be the best approach. In industrialized countries, proceeding with urethroplasty after one initial attempt at urethrotomy or dilation the most fiscally responsible approach. Patients with a high risk of stricture recurrence after endoscopic treatment should undergo treatment with urethroplasty.

• #29 A Critical Overview of Urethral Complications in Transmasculine Surgery – American Urological Association

  https://auanews.net/issues/articles/2021/april-2021/a-critical-overview-of-urethral-complications-in-transmasculine-surgery

  Complication rates published are thus low approximations. […] Until then, to define more clearly TMGRS-associated urethral complications and accurately report their rates, and to better counsel and empower individuals to choose the surgery best aligning with their goals, a critical overview must be done of the existing data and future publications. […] Standardizing terminology and reportingmuch like the International Consultation on Urological Diseases did for urethral strictures, stenoses and distraction injurieswould be beneficial.

• #30 Prevalent Practices in Male Anterior Urethral Stricture Management: A Survey

  https://openurologyandnephrologyjournal.com/VOLUME/15/ELOCATOR/e1874303X2203240/

  This article aimed to study the prevalent practices in the treatment and follow-up of urethral strictures. Moreover, the article aimed to investigate the present opinion among urologists as the treatment practices for urethral stricture disease are mostly dependent on the treating surgeons expertise and preference in the absence of widely followed standard guidelines. […] Urethral stricture is a common disease that has an estimated incidence of about 2001,200 cases per 100,000 male population, with the incidence being much higher in people aged 55 years. […] This survey on urethral stricture management amongst urologists shows that there is wide variation in the management of stricture urethra. This survey underscores the need for large-scale, long-term studies to formulate a guideline for the management of urethral stricture disease, thereby bringing uniformity in the care provided.

• #31 Prevalent Practices in Male Anterior Urethral Stricture Management: A Survey

  https://openurologyandnephrologyjournal.com/VOLUME/15/ELOCATOR/e1874303X2203240/

  Despite recent guidelines from prominent urology organizations around the world, such as the American Urology Association (AUA) and the European Association of Urology (EAU), randomized trials to provide irrefutable data on the appropriate management practices of urethral strictures are lacking. […] The success rate of urethroplasty surgery is dependent upon how a failure is defined. There is no clear consensus on defining the recurrence or failure of the procedure.

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