Recurrent Anterior Urethral Stricture: Challenges and Solutions

Abstract

Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment "failures". Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

Biodegradable polyurethane scaffolds in regenerative medicine: Clinical translation review

“…This gold standard treatment often comes with associated donor site morbidity and may have a high recurrence rate of stricture. 205 While several biomaterial scaffolds have been applied in pre-clinical clinical models, they have met with relatively little success. Natural biomaterial scaffolds currently lack the mechanical integrity to be used in segments longer than 0.5 cm, while synthetic biomaterial scaffolds have not been able…”

“…Reconstruction of long segments of urethral tissue is currently carried out by harvesting autologous tissue, primarily the buccal mucosa. This gold standard treatment often comes with associated donor site morbidity and may have a high recurrence rate of stricture 205 . While several biomaterial scaffolds have been applied in pre‐clinical and clinical models, they have met with relatively little success.…”

Evaluation of skin natural change function in split-thickness skin graft

“…The graft does not carry any part of the donor site, so it receives all the nutrients from the wound site at the recipient site. Grafts are named according to their composition, such as epidermis, dermis, fat, hair, cartilage, and bone (Mershon & Baradaran, 2021). Skin grafts move part of the skin that has been separated from its local blood supply to another location.…”