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Van Buren Sound

The Van Buren is a curved, solid stainless-steel urethral sound with a smooth rounded tip that follows the J-shaped curvature of the male urethra from the meatus through the bulb and prostatic urethra into the bladder. Graduated in French sizes (typically 8–40 Fr in 2-Fr increments). It is a traditional sound for blind sequential dilation of the male urethra.[2] Dilation is one treatment approach for urethral stricture disease.[1] The manufacturer lists the Van Buren for urethral exploration and calibration, and Wyner describes its cystoscope-assisted use for suprapubic-tube placement.[12][6]

Design​

  • Material. Solid stainless steel; reusable, autoclavable.
  • Curve. Fixed curve concentrated toward the tip, matching the bulbar and membranous bend; less acute than the Haygrove (full semicircle for the suprapubic-to-membranous corridor) and more curved than the straight Dittel female or distal-male sound.
  • Tip. Smooth and rounded (olive or bullet) to minimize mucosal trauma.
  • Shaft. Solid, rigid, uniform diameter along the working length (tapered slightly to the tip).
  • Handle. Flat broad proximal handle for precise control and tactile feedback through the urethra.
  • Sizing. French (1 Fr ≈ 0.33 mm); GerMedUSA lists Van Buren sounds from 8–40 Fr in 2-Fr increments.[12]

Reconstructive-Urology Uses​

Intraoperative urethral calibration​

  • Anterior urethroplasty. In a described dorsolateral buccal-graft onlay technique, the proximal and distal lumen are calibrated to check patency; that report does not set a 24–28 Fr final caliber or address anastomotic repairs.[14]
  • Defining normal-caliber urethra at urethroplasty. Sequential sounds are passed from each end of the stricture to find the transition into normal-caliber lumen, marking the resection or spatulation point. The ICS male LUTS-surgery terminology document defines urethral calibration as measurement of the (distal) urethral lumen with "special urethral sounds."[7]
  • Exchange sound for catheter-over-sound techniques, urethral re-entry after diversion, and assisted Council-tip / coude exchanges in the difficult-catheter patient.

Bladder access and suprapubic-tube placement​

  • Anterior-bladder tenting for SPT. A Van Buren is passed per urethra into the bladder and used to tent the anterior bladder wall against the abdominal wall, creating a palpable or cystoscopically visualized target for suprapubic cystostomy when a dedicated SPT kit is unavailable. Contraindicated in pelvic trauma with suspected urethral disruption.[6]

Urethral dilation (historical / still common)​

  • Blind sequential dilation in ascending 2-Fr steps; the mechanism is mucosal rupture at the least-scarred portion of the stricture, producing transient luminal restoration.[4]
  • Reported dilation success in the cited review is approximately 50–60% for a primary short urethral stricture and about 20% when length exceeds 2 cm.[4] The AUA guideline conditionally permits dilation, DVIU, or urethroplasty for initial treatment of a bulbar stricture <2 cm (Grade C). It reports 35–70% long-term success for dilation or DVIU in short bulbar urethral strictures and treats those two endoscopic options as interchangeable.[5][16] See the DVIU page for the full endoscopic and dilation algorithm.

Van Buren vs Other Urethral Sounds and Dilators​

FeatureVan BurenDittel (straight)Filiform + FollowersBalloon Dilator
ShapeGentle J-curve (distal)StraightFlexible tip + threaded coaxial followersInflatable cylindrical balloon
MaterialSolid stainless steelSolid stainless steelWoven / plastic filiform + metal followersCatheter-mounted balloon; material varies by device (for example, nylon)[15]
GuidanceBlind (tactile)Blind (tactile)Blind or over-wireEndoscopic or fluoroscopic direct vision
Best useMale urethral calibration / dilation, anterior urethroplastyFemale urethra or distal male urethraTight / impassable stricturesControlled radial dilation, drug-coated delivery
MechanismAxial shearingAxial shearingSequential coaxial dilationRadial force
False-passage riskPossible with blind passagePossible with blind passagePossible if a false lumen is enteredPossible despite visual guidance

Technique for Urethral Dilation​

  1. Topical 2% lidocaine jelly instilled per urethra (or regional / GA for difficult cases) plus generous lubrication.[17]
  2. Begin with the largest sound that passes without resistance to establish baseline caliber.
  3. Advance in 2-Fr increments, pausing at each size to allow tissue accommodation.
  4. Passage technique. In a known traversable lumen, hold the handle in the dominant hand, introduce the tip with the shaft near-vertical, then slowly lower the handle toward the patient's feet as the curved tip follows the bulbar bend into the prostatic urethra and bladder. Advance by gravity and gentle pressure only, never by force. For a bulbar stricture, Furr and Gelman advise against blind Van Buren passage because excess distal-urethral dilation may cause fossa-navicularis stricture; they describe direct-vision guidewire placement followed by coaxial follower dilation.[13]
  5. Endpoint. Choose the caliber for the specific indication and anatomy; 24 Fr is not an established universal target for blind Van Buren dilation.[9]
  6. Post-procedure. If a catheter is placed after uncomplicated dilation, remove it within 72 hours ; individualize drainage when complications or another indication require it. Assess antimicrobial prophylaxis according to the procedure and infection status (see Safety Profile).[10]

Safety Profile​

Complications of urethral dilation with metal sounds:[2][4]

  • False passage or urethral perforation. Gelman et al. identify these as possible complications of blind sound passage.[2] EAU 2026 weakly favors visually controlled dilation but reports no direct blind-versus-visual comparison that quantifies the risk difference.[9]
  • Urethral hemorrhage.
  • Bacteremia, UTI, sepsis. Defer dilation during active UTI; screen for and treat bacteriuria before procedures breaching the mucosa. For urethral surgery, the EAU strongly recommends intraoperative prophylaxis selected according to local resistance patterns.[4][10]
  • Stricture recurrence. The mucosal-rupture mechanism with periurethral urinary extravasation promotes additional fibrosis, contributing to the high recurrence rates beyond the short-bulbar best case.[4]

Practice Patterns and Current Positioning​

Despite guideline encouragement of visually controlled methods, blind metal-bougie dilation remains common in practice. In a survey of Turkish urologists (222 respondents, 11% response rate; conducted in 2021), 47% used blind metal-bougie dilation, 23% plastic dilators over a guidewire, and 26% disposable catheters; non-metal methods were more common in academic centers (p = 0.04).[8] The 2026 EAU guideline recommends visually controlled over blind dilation and finds no evidence that dilation is superior to DVIU. It gives a strong recommendation for a drug-coated balloon for a short (< 3 cm) bulbar stricture that has recurred after at least two endoscopic treatments in patients unfit for or unwilling to have urethroplasty.[9]

Trend Toward Visually Guided and Less Traumatic Dilation​

  • Direct-vision balloon dilation applies radial force over a guidewire under endoscopic visualization. Gelman et al. describe a more controlled technique; the EAU notes that direct comparisons with blind dilation are unavailable, so the size of any safety difference is unknown.[2][9]
  • Drug-coated balloon (Optilume) is a paclitaxel-eluting balloon for recurrent bulbar stricture; in the ROBUST III randomized trial (recurrent anterior strictures < 3 cm), 1-year freedom from reintervention was 83.2% versus 21.7% for standard DVIU or dilation.[5] See the Drug-Coated Balloon Therapy and Optilume DCB urethroplasty pages.
  • Intermittent catheterization. A systematic review of men with neurogenic lower urinary tract dysfunction describes clean intermittent catheterization as one management strategy while noting heterogeneous outcomes and a lack of standardized definitions.[3] After DVIU in other men, the AUA pooled analysis found lower recurrence with self-catheterization (RR 0.51).[5][16]

Historical Context — William Holme Van Buren​

William Holme Van Buren (1819–1883) was a New York surgeon and early American urologic educator who served as professor of surgery at Bellevue Hospital Medical College from 1868 to 1883.[11] The curved urethral sound bearing his name remains available in contemporary instrument catalogs.[12]

See also: Haygrove Sound, Gelman Visualizing Sound, Hegar Dilators, Balloon Dilator, DVIU.

References​

1. Wong SS, Aboumarzouk OM, Narahari R, O'Riordan A, Pickard R. "Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men." Cochrane Database Syst Rev. 2012;12:CD006934. doi:10.1002/14651858.CD006934.pub3

2. Gelman J, Liss MA, Cinman NM. "Direct vision balloon dilation for the management of urethral strictures." J Endourol. 2011;25(8):1249–51. doi:10.1089/end.2011.0034

3. González-Espinosa C, Castro-Nuñez P, Averbeck MA, et al. "Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction: a systematic review." Neurourol Urodyn. 2022;41(6):1248–57. doi:10.1002/nau.24982

4. Verla W, Oosterlinck W, Spinoit AF, Waterloos M. "A comprehensive review emphasizing anatomy, etiology, diagnosis, and treatment of male urethral stricture disease." Biomed Res Int. 2019;2019:9046430. doi:10.1155/2019/9046430

5. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. "Urethral stricture disease guideline amendment (2023)." J Urol. 2023;210(1):64–71. doi:10.1097/JU.0000000000003482

6. Wyner LM. "Easy suprapubic tube placement using a Van Buren sound." Urology. 2018;114:245. doi:10.1016/j.urology.2018.01.006

7. Abranches-Monteiro L, Hamid R, D'Ancona C, et al. "The International Continence Society (ICS) report on the terminology for male lower urinary tract surgery." Neurourol Urodyn. 2020;39(8):2072–88. doi:10.1002/nau.24509

8. Kaçtan Ç, Abali T, Vosoughi O, et al. "Management of urethral stricture: translating guidelines into clinical practice." World J Urol. 2026;44(1):212. doi:10.1007/s00345-026-06312-5

9. Campos-Juanatey F, Barratt R, Chan G, et al. "European Association of Urology guidelines on urethral strictures: summary of the 2026 guidelines. Update in recommendations for endoluminal management of male anterior urethral strictures." Eur Urol. 2026. doi:10.1016/j.eururo.2026.04.021

10. European Association of Urology. EAU Guidelines on Urethral Strictures: Perioperative Care of Urethral Surgery. 2026.

11. NYU Health Sciences Library Medical Archives. William Holme Van Buren, Historic Images. Accessed October 4, 2026.

12. GerMedUSA. Van Buren Urethral Sound, product catalog. Accessed October 4, 2026.

13. Furr J, Gelman J. "Endoscopic Management of Urethral Stricture Disease and Bladder Neck Contractures." J Endourol. 2020;34(Suppl 1):S7–S12. doi:10.1089/end.2018.0317

14. Prabha V, Devaraju S, Vernekar R, Hiremath M. "Single stage: dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures using perineal route." Int Braz J Urol. 2016;42(3):564–570. doi:10.1590/S1677-5538.IBJU.2015.0184

15. U.S. Food and Drug Administration. "Bard UroForce Balloon Dilation Catheter (K993840): 510(k) summary." 2000. FDA device summary.

16. American Urological Association. "Urethral Stricture Disease: AUA Guideline (Published 2016; Amended 2023)." 2023. Full guideline

17. Aspen Pharmacare Australia. "Xylocaine 2% Jelly: Product Information." Revised June 2025. Product information.