Purpose of review Anterior urethral stricture disease (USD) affects 1% of at-risk men. While urethroplasty remains the gold standard, novel adjuncts, including drug-coated balloon (DCB) dilation and intralesional treatments have re-energized the field. This review summarizes the evidence base for DVIU/dilation versus urethroplasty, outlines the efficacy, safety and cost-effectiveness of DCB and intralesional treatments, and outlines where novel endoscopic treatments should sit in the current treatment pathway. Recent findings The OPEN trial clarified the limitations of DVIU in recurrent USD, with patients who underwent urethroplasty having greater improvements in objective urinary function with less risk of reintervention. However, urethroplasty was associated with greater adverse events and higher costs; as a result, DVIU remains a cost-effective option. The ROBUST trials have established the efficacy and safety of DCB dilation in recurrent anterior USD, with durable improvements in IPSS and QMax. At 3 years, freedom from repeat intervention was 71.7% with DCB dilation, compared with 24% with DVIU. Economic evaluations suggest DCB dilation is likely cost-advantageous in settings where recurrent treatments are required. Intralesional mitomycin C and steroid injections have shown promising short-term results in small series but further data are required. Summary Endoscopic therapy remains an essential component of USD management. Future research should explore DCB dilation use in primary anterior USD treatment, long-segment disease, recurrence, and posterior urethral strictures.
Sugrue et al. (Tue,) studied this question.