This protocol addresses men with a short stricture confined to the bulbar urethra who are not eligible for urethroplasty. Because surgical reconstruction is off the table, management is directed at the endoscopic route.
First-line care in this setting centres on an endoscopic intervention performed directly at the bulbar urethra — either incisional or dilation-based. Which specific technique applies, how recurrence is managed, and what long-term stabilisation entails are all covered in the full structured regimen below.
Perform DVIU/dilatation for a primary, single, short (< 2 cm) and non-obliterative stricture at the bulbar urethra.
Perform intermittent self-dilatation (ISD) to stabilise the stricture after dilatation/direct vision internal urethrotomy (DVIU) if urethroplasty is not a viable option.
Offer drug (paclitaxel)-coated balloon dilatation for a short (< 3cm) bulbar stricture recurring after at least two prior endoscopic treatments, but only in patients for whom urethroplasty is not an option.
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