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Abstract

Background: Urethral stricture disease is a common urological condition associated with significant morbidity and high recurrence rates following direct vision internal urethrotomy (DVIU). Objective: This study aimed to evaluate the effects of catheter size and duration on recurrence rates after internal urethrotomy. Methods: This prospective observational study was conducted at Department of Urology, PIMS Islamabad, from April 2024 to January 2025. It included 201 male patients aged 18–70 years with anterior urethral stricture undergoing first-time internal urethrotomy. Patients were stratified into groups based on catheter size (14 Fr, 16 Fr, 18 Fr) and duration of catheterization (≤5 days, 6–10 days, >10 days). Recurrence was assessed during follow-up at 1, 3, 6, and 12 months using symptom evaluation, uroflowmetry, and imaging/endoscopy when indicated. Results: The mean age of patients was 43.6 ± 12.4 years. Most strictures were located in the bulbar urethra (70.6%) with mean length 1.4 ± 0.6 cm. Overall recurrence was observed in 64 patients (31.8%). Recurrence was highest in the 18 Fr catheter group (43.2%) and lowest in the 14 Fr group (23.6%) (p=0.04). Similarly, recurrence increased with longer catheterization duration, being 16.4% for ≤5 days, 33.7% for 6–10 days, and 50.0% for >10 days (p=0.002). Multivariate regression identified stricture length >1.5 cm, catheter size 18 Fr, and catheter duration >10 days as independent predictors of recurrence. Conclusion: Smaller catheter sizes and shorter catheterization durations are associated with lower recurrence rates following internal urethrotomy. Optimizing postoperative catheter management represents a simple, effective strategy to reduce recurrence and improve patient outcomes