Etiology and Management of Male Iatrogenic Urethral Stricture: Retrospective Analysis of 172 Cases in a Single Medical Center

Abstract

Purpose: To investigate the etiology and management of male iatrogenic urethral stricture in China. Methods: The data of 172 patients with iatrogenic urethral stricture who underwent treatment at a high volume reference center in China from January 2008 to February 2014 were analyzed retrospectively. Databases were analyzed to understand the impact of different types of iatrogenic injury on stricture location, length and treatment of urethral strictures, as well as success rates. Results: The most common type of iatrogenic stricture was urethral instrumentations in 80 patients (46.51%). Mean stricture length was 3.3 ± 2.54 cm and the longest strictures were those caused by intravesical instillation. Substitution urethroplasty was the most common intervention and was performed in 60.47% (104/172) of patients. The overall success rate was 85.00% (136/160). Univariable analyses revealed that the type of iatrogenic injury was significantly related to restenosis (p = 0.036), and it is more apt to postoperative restenosis in the type of intravesical instillation than others. Conclusion: Our results showed that urethral instrumentation is the most common etiology of iatrogenic urethral stricture, and most iatrogenic urethral strictures involve the anterior urethra. The different etiologies are closely associated with stricture location, length and the overall prognosis of urethral strictures.

A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury

“…39 Furthermore, some researchers also observed that ED did not differ significantly between STDU and EER. [40][41][42] Other notable complications include further urethral injury as well as an increased incidence of infection, however, none of these were observed in our study. As such, endoscopic urethroplasty using rigid ureteroscopy has a similar efficacy as flexible cystoscopy in urethral primary realignment of urethral injuries.…”

Is pre‐referral management of anterior urethral strictures prior to urethroplasty appropriate?

“…2 Because the corpus spongiosum of the penile urethra is thinner than that of the bulbar urethra, the penile urethra has a poorer blood supply and is susceptible to damage, therefore, penile stricture can be easily complicated by repeat transurethral procedures. 21 In our cohort, of 80 patients with iatrogenic penile, penobulbar, or pan-anterior urethral stricture, only 27 (33.8%) could be repaired by one-stage urethroplasty, the remainder required staged repair or perineal urethrostomy, partly because the stricture became complicated before the referral. Although referring physicians may naturally be unwilling to refer patients with iatrogenic stricture they hesitate to show the trouble, it is important in iatrogenic strictures, especially penile strictures, to refer immediately after initial diagnosis without attempting a transurethral procedure.…”

“…The AUA guideline on male urethral stricture states that urethroplasty should be offered for penile stricture as initial management, given the low success rate of transurethral procedures 2 . Because the corpus spongiosum of the penile urethra is thinner than that of the bulbar urethra, the penile urethra has a poorer blood supply and is susceptible to damage, therefore, penile stricture can be easily complicated by repeat transurethral procedures 21 . In our cohort, of 80 patients with iatrogenic penile, penobulbar, or pan‐anterior urethral stricture, only 27 (33.8%) could be repaired by one‐stage urethroplasty, the remainder required staged repair or perineal urethrostomy, partly because the stricture became complicated before the referral.…”

Factores de riesgo y estrategias de prevención para el desarrollo de estrechez uretral de origen iatrogénico: Papel del urólogo

“…El cateterismo vesical es uno de los procedimientos más comúnmente realizados en pacientes hospitalizados, y se encuentra asociado a una importante morbilidad por su relación con el desarrollo de infección urinaria nosocomial 6 además de explicar hasta el 34% de las causas iatrogénicas de la estrechez uretral. 7 La educación sobre la técnica apropiada de cateterización vesical es el primer paso hacia la prevención de esa lesión. 8 Desafortunadamente, el personal de salud técnico y profesional involucrado activamente en la elaboración del procedimiento suele poseer un grado variable de destreza para su adecuada realización, siendo en ocasiones insuficiente.…”