Bedri KazaliSamuel Almaw2025-08-072025-08-072024-06-15https://etd.aau.edu.et/handle/123456789/6196Background Urethral stricture disease in men is a prevalent urological condition that can significantly affect quality of life and healthcare costs. Despite urethroplasty being the gold standard management for urethral stricture disease, direct vision internal urethrotomy is commonly performed due to its simplicity and lower cost. However, the use of direct vision internal urethrotomy as a definitive management and its long-term outcomes, particularly in Sub-Saharan Africa (SSA), remain unknown. Objective: To assess the long-term outcomes and risk factors for failure in patients with urethral strictures who underwent direct vision internal urethrotomy as a primary intervention. Method: We carried out a retrospective study on patients with urethral stricture disease that underwent direct vision internal urethrotomy at our institution over a course of 5 year period with a minimum postoperative follow-up period of one year. The study included a comprehensive review of medical records from 79 patients who fulfilled the inclusion criteria. The Kaplan-Meier curve was used to characterize the recurrence-free survival, and multivariable COX regression analysis was carried out to predict treatment failure. Predictors evaluated included location, length, etiology, number and type of strictures, comorbidities, and age of the patients. Result : The Mean age was 59.8 ± 14.9 years.Of the 79 patients, 88.6% had a single stricture, of which 62% had a stricture length between 11 and 20mm while 11.4 % had a stricture length ≤ 10mm. Bulbar urethral strictures accounted for 75.9% of cases. The mean follow up duration after the procedure was 31.1±16.7(range:12 to 69) months.The recurrence rate was 57%,68.4%, 82.3%, and 88.6% at 3,6,12, and 24 months respectively. The mean time to recurrence was 4.4 ± 4.5 (range: 1 to 24) months. Multivariate regression analysis demonstrated, soft non-obliterating stricture type and stricture length ≤10mm were significantly associated with recurrence-free survival with hazard ratio of 14.1 ; 95 percent confident interval ( 2.78 – 72.0) with P < 0.001 and hazard ratio of 46.9 ,95 percent confident interval, (1.4 - 1568.5) with P=0.032 respectively. Conclusion Direct vision internal urethrotomy is associated with an unacceptible high recurrence rate among out patient population. Soft, non-obliterating strictures and those strictures with less than or equal to10mm length had lower recurrence.Further prospective studies are required in low-income setting to clearly define the patient population that could benefit from this procedure.en-USVISION INTERNAL URETHROTOMYThesis