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Abstract

The above commentary nicely crystallizes the basic pathophysiological tenants of stricture formation and explains how increasing age is theorized to place patients at risk of poor outcomes. Our collective experience demonstrates that patients are often indiscriminately subjected to age bias when counseled on the various treatment options for urethral stricture disease. There appears to be a decidedly lower threshold to employ repetitive, even scheduled endoscopic treatments for older patients in an effort to avoid “major surgery.” Heyns et al analyzed pre-referral stricture management for patients who eventually underwent urethroplasty, noting that patients with 5-6 endoscopic interventions before referral had an average age of 60.2 years vs 46.6 years in those receiving 1-2 interventions. 1 Heyns C.F. van der Merwe J. Basson J. van der Merwe A. Treatment of male urethral stricture—possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty. S Afr J Surg. 2012; 50: 82-87 Crossref PubMed Google Scholar The unintended consequence from this phenomenon is strictures that are unnecessarily more complex when they are eventually referred for reconstruction.