Anterior Urethral Strictures: A Brief Review of the Current Surgical Treatment

Abstract

A review of the recent literature on the surgical management of anterior urethral stricture was performed. The literature was searched via PubMed using the search terms ‘urethral stricture’ and ‘urethroplasty’ from 1996 to 2009. The management of anterior urethral strictures is changing rapidly in the sense that the reconstructive procedures have evolved greatly. Penile skin, because of its location and because it is hairless, has been popular and used for a long time. Since the early 1990s, buccal mucosa graft (BMG) was introduced in urethral reconstructive surgery and has become the first choice of most practicing urologists. Recently, there has been an increase in the use of lingual mucosa graft with various doctors reporting easy harvesting and lesser morbidity in comparison to BMG. Also, fibrin glue has recently been used to fix the graft with promising results. With the success of tissue-engineered materials that are still in the experimental phase, the urologist would no longer be limited by the quantity of the graft. These substitutes will also boost the appealing scarless endoscopic urethroplasty. This article provides a brief up-to-date review of the main surgical techniques in the management of anterior urethral stricture disease for the contemporary practicing urologists. Present controversies have been given special emphasis. The possible future techniques and the future of the anterior urethral stricture surgery are also discussed in brief.

High-pressure balloon dilation for male anterior urethral stricture: single-center experience

“…On the contrary, urethroplasty was traditionally considered a difficult surgical procedure and reserved for much more complex cases, although advanced with better longterm cure rates (Singh et al, 2011). However, it has been demonstrated that endoscopic surgery was superior to urethroplasty as long as the stricture did not exceed 2 cm in length, given its low morbidity and rapid convalescence (Wright et al, 2006;Hameed et al, 2011;Veeratterapillay and Pickard, 2012;Tinaut-Ranera et al, 2014).…”

Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty

“…A wide variety of techniques have been described for the treatment of the anterior urethra, including dilations, urethrotomy, end-to-end urethroplasty, graft urethroplasty, flap urethroplasty and two-stage urethroplasty; success rates depend on the study and the type of treatment. 8,9 Surgical treatment of the posterior urethra (including bulbar urethra) is more standardized and is generally related to the length of the stricture. A urethrotomy is preferred if the length is less than 1 cm, and a urethroplasty is indicated when the length is greater than 1 cm.…”

Oral Mucosa Graft: An Ideal Substitute for Urethroplasty

“…Published online 19 Urethral reconstructive surgery has always been a challenging part for urologist since the dawn of our speciality. In this book leading experts in lower urinary reconstructions from all over the world present their views and experience in that field, together with practical tips and tricks.…”

“…Current enthusiasm for the technique was promoted by Duckett 1986, (8) Burger and associates 1992 (9), Dessanti and colleagues 1992 (10) and Elkasaby et al (11) In the following years, numerous reports had described successful use of buccal mucosal graft in the repair of urethral defects associated with previously failed hypospadias surgery and those associated with urethral stricture. (12)(13)(14)(15)(16)(17)(18)(19) Nowadays, buccal mucosa has become the mainstay of these tissue transfer techniques. (13) In February 2006, Simonato et al (20) described the results of the first pilot study on the use of the tongue as an alternative donor site for graft urethroplasty with good functional and aesthetic results.…”