Urethroplasty in the management of urethral strictures: a literature review

Abstract

Urethral stricture is defined as pathological urethral narrowing caused by corpus spongiosum fibrosis. The etiology of this condition is mostly idiopathic, which can also result from iatrogenic (like previous urethral surgeries, catheterization, or resection), inflammatory and traumatic causes. The evidence discussing the management of urethral strictures is scarce. The management starts with an appropriate evaluation of the condition through a comprehensive history taking (obstructive symptoms) and physical examination. Diagnostic investigations include cystoscopy (the most specific), urethrography, patient reported scales, like American urological association symptom index, uroflowmetry, and retrograde urethrography. Previous literature shows urethroplasty is cost effective, whether when it is used as the primary treatment or following a non-successful dilation and direct visualization internal urethrotomy. Moreover, open urethroplasty and endoscopic urethrotomy were comparable among both procedures in terms of voiding improvement; however, urethroplasty benefit was more durable. Akin to that, urethroplasty was found to be a successful procedure in up to 95% of the cases with the appropriate experience level. Although excision and primary anastomosis and augmentation/substitution urethroplasties have considerable long-term success rates, the EPA procedures have a controversial influence on sexual function, which may be unacceptable to some reconstructive urologists. In general, there are a few large scales, multi center studies that can produce high-quality evidence. There is an urge to develop more high-grade research in terms of ideal management of urethral strictures.