Abstract
Urethral stricture disease affects many men worldwide. Traditionally, the investigation of choice has been urethrography and the management of choice has been urethrotomy/dilatation. In this review, we discuss the evidence behind the use of ultrasonography in stricture assessment. We also discuss the factors a surgeon should consider when deciding the management options with each individual patient. Not all strictures are identical and surgeons should appreciate the poor long-term results of urethrotomy/dilatation for strictures longer than 2 cm, strictures in the penile urethra, recurrent strictures, and strictures secondary to lichen sclerosus. These patients may benefit from primary urethroplasty if they have many adverse features or secondary urethroplasty after the first recurrence.
Highlights
IntroductionThis update will concentrate on the advances in the investigation and management of urethral stricture disease in men
First published: 09 Feb 2016, 5(F1000 Faculty Rev):[153]. This update will concentrate on the advances in the investigation and management of urethral stricture disease in men. Urologists have offered such men urethral dilatation/urethrotomy, which carries the risk of needing repeat interventions and a longterm need to self-dilate the urethra on a regular basis
All urethrograms were performed by a urologist and it is not known whether the radiologist would have obtained the same results had they performed and reported the studies
Summary
This update will concentrate on the advances in the investigation and management of urethral stricture disease in men. A urethral stricture is a narrowing of the urethra. A “true” stricture is the result of ischaemic spongiofibrosis manifesting as scar tissue in the corpus spongiosum[1]. Contraction of this scar tissue leads to a reduction in the urethral calibre, which leads to voiding difficulty. Urethral distraction injuries occur as a result of blunt trauma distracting the two ends of the urethra apart and are not “true” strictures. Ischaemic spongiofibrosis may be due to infection such as gonococcal urethritis, inflammation such as lichen sclerosus, or instrumentation; the majority of strictures are idiopathic. In the US, on the basis of 10 public and private databases between 1992 and 2000, there were 5 million office visits per year and more than 5,000 inpatient admissions per year due to urethral strictures[2]
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