Records of urethral stricture diseases can be traced back to ancient times. Although it is one of the oldest urological diseases, we still have poor understanding of this disease. Among various types of urethral strictures, anterior urethral strictures are most common, accounting for more than 90%. In order to learn the current diagnosis and treatment of anterior urethral strictures among urologists in China, and explore the differences with developed countries and anterior urethral strictures guidelines, we carried out this study, looking forward to providing valuable suggestions for its diagnosis and treatment.

Based on the prior surveys, we designed the questionnaire suitable for Chinese urologists by referring to relevant literature, consulting the experts in the filed of urethral reconstruction. The survey consisted of respondent demographics, preoperative evaluation, surgery related experience and postoperative management. This study utilized a non-probabilistic “voluntary” sampling designed to elicit maximum participation by consenting general urologists. Next we sent it to the general urologists via WeChat, the most popular social media software in China, in a network link. It was conducted from March 19, 2020 to April 10, 2020, and lasted 2 weeks. Using descriptive and multiple correspondence analysis to analyze the data.

1267 valid questionnaires were obtained. The diagnostic methods of anterior urethral stricture is diverse, urethrography (90.7%) and urethrocystoscopy (85.4%) were the most commonly used, which is similar with prior surveys. Urethral dilation (92.3%) and internal urethrotomy (60.1%) were the main treatment procedures. End-to-end urethroplasty (45.2%) was the most commonly used open surgery, followed by skin flap urethroplasty (14.9%) and free graft urethroplasty (12.4%). They were preferred to choose buccal mucosal(54.2%) to perform urethroplasty, which is consistent with the recommendations of the guidelines. Cold knife (57.1%) was the most used method for internal urethrotomy. 77.3% of urologists performed less than 5 open urethral surgeries last year, and only 8.9% more than 10 cases. 46.8% of urologists have no urethral reconstruction training. 76.2% of urologists insisted on using urethroplasty only after the failure of minimally invasive surgery (reconstructive ladder strategy), 23.8% thought that urethroplasty should be performed at the first if the indication was appropriate, which is similar with developed countries. In addition, urologists attended training have a strong correlation with senior practice type, middle-aged and elderly. They are tend to perform more urethroplasties and the type is various. Urologists not attended training have a strong correlation with attending urologists and young urologists. They are tend to perform minimally invasive surgery and less open urethral surgeries.

As far as we know, this survey is the largest number of participates in the existing anterior urethral stricture survey, and the first survey about anterior urethral stricture in China, Asian, and even developing countries. Although it has been 13 years since the first survey in the United States, our survey results found that the overall diagnosis and treatment concept of anterior urethral strictures in China has not changed much, compared with developed countries. Furthermore, the results suggested that urologists attended training are more inclined to select urethroplasty to treat anterior urethral stricture (P<0.01).

The treatment of anterior urethral strictures in China is still dominated by minimally invasive surgery. The majority of urologists insisted on using reconstructive ladder strategy. In general, compared with developed countries, the overall diagnosis and treatment strategy of anterior urethral strictures are similar, and there is still some gaps with the anterior urethral stricture guidelines.