Surgical treatment of anterior urethral stricture diseases: brief overview

Abstract

We performed an up-to-date review of the surgical techniques suggested for the treatment of anterior urethral strictures. References for this review were identified by searching PubMed and MEDLINE using the search terms "urethral stricture" or "urethroplasty" from 1995 to 2006. Descriptive statistics of the articles were provided. Meta-analyses or other multivariate designs were not employed. Out of 327 articles, 50 (15%) were determined to be germane to this review. Eight abstracts were referenced as the authors of this review attended the meetings where the abstract results were presented, thus it was possible to collect additional information on such abstracts. Urethrotomy continues to be the most commonly used technique, but it does have a high failure rate and many patients progress to surgical repair. Buccal mucosa has become the most popular substitute material in urethroplasty; however, the skin appears to have a longer follow-up. Free grafts have been making a comeback, with fewer surgeons using genital flaps. Short bulbar strictures are amenable using primary anastomosis, with a high success rate. Longer strictures are repaired using ventral or dorsal graft urethroplasty, with the same success rate. New tools such as fibrin glue or engineered material will become a standard in future treatment. In reconstructive urethral surgery, the superiority of one approach over another is not yet clearly defined. The surgeon must be competent in the use of various techniques to deal with any condition of the urethra presented at the time of surgery.

Outcome of Urethral Strictures Managed by General Surgeons in a Rural Setting of India

“…The urethral strictures were categorized based on their size: mild, <1 cm; moderate, 1.1-2 cm and severe, >2 cm. The strictures were treated with periodic urethral dilatations, internal optical urethrotomy (IOU) or urethroplasty [3,6]. The choice of the procedure was left to the individual surgeon.…”

“…Several interventions such as dilations, optical internal urethrotomy and open urethroplasty are used to treat urethral strictures but none has produced outcomes that are satisfying to the patients. According to a narrative review, [3] most patients with urethral stricture are offered urethrotomy-a technique associated with high failure rates. Although open urethroplasty is the current gold standard against which the traditional treatments are compared, this technique needs skills, expertise and equipment, often not available in the resource limited settings [1,4,5].…”

Combined Dorsal Plus Ventral Double-Graft Urethroplasty in Anterior Urethral Reconstruction

“…Perineal trauma, long-term urethral catheterization, urological instrumentation, chronic inflammatory disorders such as lichen sclerosis et atrophicus, and sexually transmitted disease are typical causes of strictures: most cases, however, are idiopathic, probably arising as a result of remote unrecognized straddle injury during childhood [2]. If the urethral stricture cannot be treated properly, it will have a negative effect on the quality of life and also put heavy economic burden on their family [3].…”

“…Open urethroplasty is regarded as the gold-standard treatment of resistant urethral stricture disease [5], whereas longer strictures (>2.5 cm), or those in a distal location along the penile shaft, usually require a urethral substitution procedure incorporating a graft or flap to augment the stenotic segment [5]. Over the past decade, buccal mucosa graft (BMG) has become popular for complex urethral reconstruction because it is readily available in all patients, has robust handling characteristics, and has been associated with excellent outcomes [3,6,7].…”

Penile fasciocutaneous flap urethroplasty in long segment urethral stricture

“…There are many methods used for the treatment of urethral stricture including simple bougie dilatation, visual optic internal urethrotomy, laser urethrotomy, stent placement, balloon dilatation, endoscopic urethroplasty, primary anastomotic urethroplasty, and substitution urethroplasty with flaps and grafts. [2,3] The treatment of long segment urethral strictures is a very challenging problem for urologists and patients as dilatation and visual urethrotomies do not provide long term success for these cases in general. Substitution urethroplasty with flaps or grafts will be the preferred treatment in these patients.…”