Endoluminal treatments are frequently used for male anterior urethral strictures (USs). We aim to summarize the current evidence assessing the clinical implications for each treatment. Details on epidemiology, diagnosis, open surgical management, and follow-up of US are beyond the scope of this paper, and we refer the reader to the full text Guidelines (Lumen et al. , 2026) [1].
New evidence was identified using a priori criteria. Selected literature was summarized, and recommendations were developed to prioritize clinically important decisions.
Direct vision internal urethrotomy (DVIU) is safe, with success rates improving for shorter, untreated bulbar US. Short recurrences after urethroplasty could be managed using DVIU. Single dilatation offers outcomes similar to those of DVIU, with reduced complications if visually controlled. Self-dilatation, urethral stents, and local corticosteroids could prolong treatment intervals but risk US worsening. Drug-coated balloon dilatation is a promising second-line endoluminal option for bulbar US.
Endoluminal treatments for male anterior USs are safe, offering good long-term patency rates in selected situations. They are an alternative for patients aiming for a less invasive management but with low long-term success. Discussion of individual options and tailoring male anterior US treatment-including referring for urethroplasty when indicated-should be granted.
European urology. 2026 May 11 [Epub ahead of print]
Felix Campos-Juanatey, Rachel Barratt, Garson Chan, Kostas Dimitropoulos, Francesco Esperto, Tamsin J Greenwell, Francisco E Martins, Nadir I Osman, Maciej Oszczudlowski, Achilles Ploumidis, Silke Riechardt, Wesley Verla, Marjan Waterloos, Carla Bezuidenhout, Nicolaas Lumen
Urology Department, Marques de Valdecilla University Hospital, School of Medicine, University of Cantabria, IDIVAL, Santander, Spain. Electronic address: ., Department of Urology, University College London Hospital, London, UK., Division of Urology, University of Saskatchewan, Saskatoon, Canada., Department of Urology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece., Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico of Rome, Rome, Italy; Research Unit of Urology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Italy., Department of Urology, Santa Maria University Hospital, University of Lisbon., Department of Urology, Royal Hallamshire Hospital, Sheffield, UK., Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland., Department of Urology, Athens Medical Centre, Athens, Greece., Department of Urology, Hospital Itzehoe, Itzehoe, Germany., Division of Urology, Gent University Hospital, Gent, Belgium., Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium., European Association of Urology Guidelines Office, Arnhem, The Netherlands., Division of Urology, AZ Maria Middelares, Gent, Belgium.