Treatment Trends for Anterior Urethral Stricture: An International Survey on Eligibility for Staged Urethroplasty.

Background and objective: Anterior urethral strictures impact quality of life and often require surgical intervention. Urethroplasty is the definitive treatment, but consensus on the best approach or timing, particularly for staged procedures, is lacking. The aim of our study was to identify factors influencing the decision to perform staged versus one-stage urethroplasty and determine key factors for the timing of the second stage. Methods: We conducted a cross-sectional survey to identify factors influencing surgical decision-making for urethral stricture treatment in adult patients. A survey designed for the study was distributed to 190 reconstructive urologists, of whom 187 returned complete responses. Responses were anonymous to minimize bias. The data were analyzed using STATA 18.0. Key findings and limitations: Factors influencing staged urethroplasty included previous surgeries (74.3%), stricture length (67.9%), and etiology (65.7%). Timing of the second stage is determined by urethral plate characteristics and surgical plate length, with 56.7% of the respondents reporting that the second stage is performed within 6 mo. Notably, 37.4% do not use standardized symptom scales. Findings highlight the role of mentoring and training in surgical choices, which points to a need for standardized guidelines. Limitations include the use of a convenience sample and self-reported data, which may introduce bias. Conclusions and clinical implications: Key factors influencing staged urethroplasty decisions include stricture length and prior surgeries. Most urologists schedule the second stage within 6 mo, guided by mentoring. Future research should develop international staging guidelines, standardize treatments, and assess long-term outcomes for consistent practices. Patient summary: We carried out a survey to find out why urologists choose one- or two-stage surgery to repair narrowing of the urethra, and when they perform the second stage. Two-stage procedures are often used for complex cases and patients who have had previous surgeries, with the second stage mostly done within 6 months. Better tools to measure patient symptoms are needed to improve care.