Abstract
BACKGROUND: The treatment of urethral stricture, particularly long-segment urethral stricture, poses a significant challenge in urological reconstruction. High-pressure balloon dilation has gained widespread recognition as an effective and safe therapeutic option. However, studies on its long-term outcomes, especially for long-segment urethral stricture, remain scarce. This study aims to establish the clinical baseline efficacy and safety of urethral balloon dilation at a tertiary care center and to provide context through an exploratory comparison with a contemporaneous cohort treated with direct vision internal urethrotomy (DVIU)/dilation. METHODS: There were 128 patients with urethral strictures who underwent endoluminal treatment at our center between November 2017 and September 2023. Of these 128 patients, 64 underwent balloon dilation and 64 underwent DVIU/dilation. Demographic and stricture characteristics data were collected. The endpoint was defined as the recurrence of strictures requiring intervention. The efficacy and safety of balloon dilation were analyzed, including outcomes by stricture length within the balloon dilation group. Comparative outcomes with the DVIU/dilation group were explored cautiously due to baseline differences. RESULTS: The median follow-up duration was 26 months for the balloon dilation group and 43 months for the DVIU/dilation group. Patients in the balloon dilation group generally had more complex strictures. The overall 1-year success rate for balloon dilation was 70.1%. Within the balloon dilation group, the 1-year success rate for long-segment strictures (≥2 cm) was 70.0%, and for short-segment strictures (<2 cm) was 70.6%, indicating comparable performance across these lengths in this cohort. The overall incidence of complications in the balloon dilation group was 20.3%. The DVIU/dilation group had an overall 1-year success rate of 70.2%. An exploratory subgroup analysis comparing patients with long-segment strictures (≥2 cm) in both treatment arms showed a success rate for balloon dilation (70.0%) that was markedly superior to that for DVIU/dilation (36.4%) within this specific subgroup (P=0.03, hazard ratio =2.48). CONCLUSIONS: Balloon dilation represents an effective and safe method for the management of both short and long-segment urethral strictures. These findings establish a valuable clinical baseline for conventional balloon dilation.