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Van Buren Sound

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). The Van Buren is the classic North American urethral sound — used historically for blind sequential urethral dilation, and still routine for intraoperative urethral calibration at urethroplasty, anterior-bladder tenting for suprapubic-tube placement, and exchange-sound work during urethral instrumentation.[1][2]

Design​

  • Material — solid stainless steel; reusable, autoclavable.
  • Curve — gentle fixed curve concentrated toward the tip (~ 170°), matching the bulbar / membranous bend; less acute than the Haygrove (full semicircle for the suprapubic-to-membranous corridor) and more curved than the straight Dittel female / distal-male sound.
  • Tip — smooth, rounded (olive / 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), 8–40 Fr, 2-Fr increments; common therapeutic endpoint ~ 24 Fr (8 mm).

Reconstructive-Urology Uses​

Intraoperative urethral calibration​

  • Anterior urethroplasty — calibrating the proximal and distal lumen at the anastomosis and confirming a 24–28 Fr final caliber at the end of buccal-graft onlay or anastomotic urethroplasty.
  • Defining normal-caliber urethra at urethroplasty — passing sequential sounds from each end of the stricture to find the transition into normal-caliber lumen, marking the resection / spatulation point. The ICS male LUTS-surgery terminology document defines urethral calibration as measurement with "special urethral sounds" — the Van Buren is the canonical example.[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 / 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; mechanism = mucosal rupture at the least-scarred portion of the stricture, producing transient luminal restoration.[4]
  • Durability for primary short bulbar stricture ~ 50–60%, falling to ~ 20% for strictures > 2 cm; AUA treats dilation and DVIU as interchangeable first-line options for short bulbar disease with similar long-term outcomes.[4][5] See the DVIU page for the full endoscopic / 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 followersPolyethylene balloon on catheter
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 riskHigher (rigid, blind)Higher (rigid, blind)Lower (flexible filiform negotiates lumen)Lowest (direct vision)

Technique for Urethral Dilation​

  1. Topical 2% lidocaine jelly instilled per urethra (or regional / GA for difficult cases) plus generous lubrication.
  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 — 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 force.
  5. Endpoint ~ 24 Fr or the desired caliber.
  6. Post-procedure — short-interval catheter at operator's discretion; periprocedural antibiotic prophylaxis given the bacteremia risk of urethral instrumentation.

Safety Profile​

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

  • False passage / urethral perforation — the most feared complication; rigid blind sounds carry higher risk than visually guided techniques.[2]
  • Urethral hemorrhage.
  • Bacteremia, UTI, sepsis — periprocedural antibiotic prophylaxis recommended; dilation should not be performed during active UTI.[4]
  • 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. A Turkish urology survey found 47% using 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 notes that single-session dilation offers outcomes similar to DVIU with reduced complications when visually controlled, and identifies the drug-coated balloon as a promising second-line endoluminal option for recurrent bulbar strictures.[9]

Trend Toward Visually Guided and Less Traumatic Dilation​

  • Direct-vision balloon dilation — radial force under endoscopic visualization; minimal false-passage risk.[2]
  • Drug-coated balloon (Optilume) — paclitaxel-eluting balloon for recurrent bulbar stricture; ROBUST III 1-yr freedom from reintervention 83.2% vs 21.7% for standard DVIU/dilation.[9] See the Drug-Coated Balloon Therapy and Optilume DCB urethroplasty pages.
  • Intermittent self-dilation with hydrophilic catheters — reduces stricture recurrence by up to 68% after DVIU.[3]

Historical Context — William Holme Van Buren​

William Holme Van Buren (1819–1883) was a New York surgeon and early American urologic educator, co-founder of Bellevue Hospital Medical College and an early proponent of standardized French-sized urethral instrumentation in the United States. The sound bearing his name remained the dominant metal urethral sound in American urology through the 20th century and persists on every urologic back table today.

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