Meatal and glandular urethral strictures

Abstract

Distal urethral strictures comprise meatal or glandular stenoses and occur due to trauma, iatrogenic instrumentalization, infection, skin diseases such as lichen sclerosus or idiopathically. Given that 18% of anterior strictures (bulbar, penile, or glandular) are located in the very distal part, meatal/glandular stricture disease represents anon-negligible subgroup among all urethral strictures. The prevalence within Western industrialized countries is estimated to be approximately 0.6-0.9%, which translates into atotal of 250,000 men being affected in Germany. Without any therapy, there is asevere risk of functional damage to the kidneys and the remaining urinary tract as well as significant reduction of quality of life. The therapeutic success of regaining sufficient micturition and asatisfying cosmetic result can only be obtained by means of surgical intervention. Besides dilatation and urethrotomy, preferably asingle or multiple staged open urethroplasty with transplantation of autogenous genital or non-genital tissue can be performed. The choice of the appropriate surgical concept depends on stricture etiology, comorbidity status, and the patient's compliance. In case of histologically diagnosed lichen sclerosus, the use of genital skin should be avoided. To date, there are no universally accepted recommendations regarding the optimal use of substitution techniques. However, the use of oral mucosal tissue grafts seem to be the most promising, given low recurrence rates, and thus can be considered as the current gold standard.