Evaluation and Treatment of Urethral Stricture Disease

Abstract

Any process causing trauma to the urethral tissue or underlying corpus spongiosum can lead to urethral stricture disease. The traditional treatment algorithm for urethral strictures, also known as the reconstructive ladder, begins with minimally invasive interventions, including urethral dilation and endoscopic urethrotomy. Inevitably, endoscopic incision and dilation fails, resulting in stricture recurrence. After the expenditure of valuable time and resources, physician and patient frustration finally leads to tertiary center referral with reconstructive urologic expertise. With dramatic advances in urethral surgery, many experts are abandoning the once-favored reconstructive ladder. In light of the excellent success rates for urethroplasty, the controversy continues, as reconstructive specialists now support open surgical treatment over endoscopic management for most urethral strictures.