Abstract
Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether.
Highlights
Urethral stricture is defined as a narrowing of the urethra
We found the rate of sexual complications after anastomotic urethroplasty to be higher than that for a matched cohort of buccal urethroplasty patients, the buccal group had much longer strictures[22]
Dorsal onlay buccal urethroplasty with unilateral urethral dissection and penile inversion through a perineal incision: Kulkarni technique In 2000, a one-stage repair of very long and pan-urethral strictures was described by Kulkarni et al, who used buccal mucosal grafts and a penile inversion exposure[41]
Summary
Urethral stricture is defined as a narrowing of the urethra. The urethral mucosa is enveloped by corpus spongiosum. Dorsal onlay buccal urethroplasty with unilateral urethral dissection and penile inversion through a perineal incision: Kulkarni technique In 2000, a one-stage repair of very long and pan-urethral strictures was described by Kulkarni et al, who used buccal mucosal grafts and a penile inversion exposure[41] This repair has since been refined by using a unilateral mobilization to preserve the urethral blood supply[38]. This optimized procedure is very satisfactory for the treatment of the worst sorts of strictures and supplants the former use of highly morbid, staged urethroplasty or fasciocutaneous flaps This technique yields an 80–83% long-term success rate despite being used in patients with features that might increase failure: very long strictures, lichen sclerosus, or failed previous urethroplasty[42,43,44,45]. This is an off-label use of Botox® (Allergan, Dublin, Ireland) and will be limited to stricture locations far enough away from the urinary sphincter that they will not cause incontinence
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