European Association of Urology Guidelines on Urethral Strictures: Summary of the 2026 Guidelines. Update in Recommendations for Endoluminal Management of Male Anterior Urethral Strictures.

Abstract

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.