Etiology Of Urethral Stricture Research Articles

Is urethral stricture really so often idiopathic? Exploring the etiology of urethral strictures in males undergoing urethroplasty: a multicenter retrospective cohort study.

The aim of this study was to retrospectively evaluate the etiology of urethral stricture disease (USD) in a large series of patients undergoing urethroplasty. The multicenter retrospective cohort study was conducted at two reconstructive urology referral centers in years 2015-2022. Prior to the surgical intervention, all patients underwent diagnostic procedures including retrograde urethrography and voiding cystourethrography. We collected comprehensive demographic and medical data including the length and location of the stricture. We paid particular attention to identifying the underlying causes of USD in the medical records. The study included 949 patients meeting criteria, with a mean age of 53. The primary cause of USD was identified as iatrogenic (404 cases, 42.6%), followed by trauma (210, 22.1%), previous hypospadias repair (122, 12.9%), lichen sclerosus (32, 3.4%), and infections (12, 1.3%). Notably, 169 patients (17.8%) did not have a discernible cause for their USD and were thus classified as idiopathic. Furthermore, it was observed that 66% of idiopathic USD cases were localized in the bulbar urethra. The etiology of USD varied significantly based on its localization (p <0.01). The mean stricture length differed among different causes, with the longest in patients with USD due to lichen sclerosus (41 mm), followed by previous hypospadias repair (35 mm), and iatrogenic causes (29 mm), p <0.001. Careful medical history-taking can identify the etiology of urethral stricture in over 80% of patients undergoing urethroplasty. The etiology of the USD impacts its location and length and thus can affect surgical treatment strategy and outcomes.

Is urethral stricture really so often idiopathic? Exploring the etiology of urethral strictures in males undergoing urethroplasty: A multicenter retrospective cohort study

Is urethral stricture really so often idiopathic? Exploring the etiology of urethral strictures in males undergoing urethroplasty: A multicenter retrospective cohort study

Analysis of prognostic factors of failure in perineal urethrostomy.

To identify prognostic factors of failure in patients undergoing perineal urethrostomy (PU) with Blandy technique, with inverted U-shaped perineal flap. This is a retrospective study of PU of non-oncological causes (2001-2017). Data of age, BMI, history of diabetes mellitus, etiology of urethral stricture, type of stricture, previous surgeries, dilatation and suprapubic catheter were collected. Failure was defined as the need for any instrumentation after surgery. Variables were analyzed by Cox regression and Kaplan-Meier curves were used for survival analysis. A total of 115 PU were performed. Median age was 61years (IQR 53-68) and BMI 27.9 (IQR 25-30.9). The most frequent etiologies were: lichen sclerosus (30.4%), iatrogenic (27%), and idiopathic (25.7%). 62.6% had panurethral stricture. There were no complications in 73%. Clavien I complications occurred in 25.2%, Clavien II in 0.9% and Clavien IVa in 0.9%. The overall success rate was 51.3% with a median follow-up of 71months. In the last 8years, it was 75%. In the multivariate analysis, we found that age (p = 0.01), BMI (p = 0.01), date of surgery (p = 0.01), and suprapubic catheter (p = 0.003) were predictive variables. The voiding satisfaction rate was 88.7%. PU with Blandy technique is a surgery with low morbidity. During the entire study period, it had a failure rate of 48.7% but the failure rate decreased to 25% over the last 8years. Age, BMI, date of surgery and suprapubic catheter are the most important prognostic factor of failure.

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China.

Background: Male urethral stricture is a disease with a high incidence rate. With social-economic development in the developing countries, the trend of etiology and treatment of male urethral stricture changed was speculated.Methods: The clinical data of the male patients with urethral stricture from 2000 to 2019 were analyzed. The subjects were divided into Group A (2000–2009) and Group B (2010–2019) according to treatment time. The pooled analysis of the data extracted from pieces of literature was also performed.Results: About 540 patients were included in the present study, including 235 patients in Group A and 305 patients in Group B. In recent 10 years, trauma has still been the main cause of urethral stricture. Iatrogenic injury, especially transurethral operation, increases significantly, while male urethral stricture secondary to radiotherapy and infection decrease. Urethroplasty increases and the reoperation rate decreases in treating simple urethral stricture, and flap urethroplasty also increases in treating complex urethral stricture. The results of a pooled analysis of data from 11 centers in Mainland China are partially consistent with it. Complications, such as urethral fistula, false canal, ejaculation disorder, and penile curvature, decrease significantly.Conclusions: The main causes of urethral stricture in the recent 10 years are still trauma and iatrogenic injuries, and the etiology of urethral stricture is related to socioeconomic development. With the increase of intracavitary minimally invasive treatment and flap urethroplasty, the curative effect is increasing, while iatrogenic urethral stricture cannot be ignored.

MONOPOLAR VS BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE REGARDING THE INCIDENCE OF POSTOPERATIVE URETHRAL STRICTURE: A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTIONBenign prostatic hyperplasia (BPH) is a very common illness affecting aged men, about half of patients will at some time need surgical intervention.Monopolar TURPis considered as the gold standard for the surgical treatment of BPH. Multiple studies showed higher complication rates in M-TURP operations in patients with large prostate volumes. The risk of hemorrhage is also higher specially in patients with blood disorders. Bipolar TURP, an electric current completes its circuit outside the body of the patients. This permits the use of saline as irrigating fluid, preventing the TUR syndrome and hyponatremia. Addionally B-TURP is associated with less bleeding and less operative time.The incidence of urethral stricture after transurethral resection of prostate (TURP) ranges from 2.2 to 9.8%. Most of the cases occurs within 6 months of transurethral surgery. Presentation is likely with weak flow, infection or acute urinary retention.The exact etiology of urethral stricture after TURP is still unknown. Suggested causes after TURP include infection, mechanical trauma, prolonged indwellingcatheter time,local anesthesia, and electrical injury.

The one-stage balloon dilatation with stone extraction for a combination of short urethral stricture and urethral stone in men

Introduction. The literature highlights isolated studies examining approaches to the treatment of patients with a combination of stones and urethral stricture. In this regard, the problem of creating optimal tactics for managing such patients remains relevant.Purpose of the study. To analyze of own experience in treating patients with a combination of stricture and urethral stone using balloon dilation with urethral stone extraction.Materials and methods. The study included 7 men with short urethral stricture and stone, who underwent balloon dilation with urethral stone extraction. The age of patients ranged from 47 to 65 years (median - 52 years). The length of the urethral stricture ranged from 3 to 10 mm (median - 7 mm). The stricture in 2 (28.6%) cases was localized in the penile part of the urethra and 5 (71.4%) in the bulbous part. An etiology of urethral strictures: traumatic - in 2 (42.9%) patients, inflammatory - in 1 (14.3%) of cases, idiopathic - in 4 (57.1%) of cases. All patients had 1 urethral stone. The sizes of the stone ranged from 4 to 9 mm (median - 6 mm).Results. The operation time ranged from 11 to 19 min (median - 13 min). No patient had any intraoperative complications. UTIs was observed in the early postoperative period in 1 patient. The duration of postoperative hospital stay ranged from 1 to 5 days (median - 3 days). Postoperative follow-up ranged from 3 to 24 months (median - 14 months). Only 1 (14.3%) patient had a recurrence of urethral stricture 18 months after treatment. Thus, the overall treatment success in this group of patients was 85.7% (6/7).Conclusion. We used this conjunction approach when combined stricture and urethral stone in men for the first time in the world. It seems quite promising given the results.

Types of urethral stricture and their recurrence rates post urological treatments

Urethral strictures can significantly impact the quality of life for patients because it can be associated with significant complications such as fistulas, bladder calculi, infections and sepsis. Additionally, it might even lead to renal failure. The worldwide prevalence of urethral strictures is high, with an estimated rate of 229-627 patients per 100,000 population. In this literature review, the aim was to discuss the types and etiology of urethral strictures and the recurrence rates following the different management modalities. Studies that were included in this review were published between January 2005 until May 2021. The results support the current evidence that the idiopathic and iatrogenic bulbar strictures are the most common types while penile strictures, the iatrogenic and inflammatory are the most common causes. Recurrence rates are reported after management with almost all of the current management modalities, indicating the need for better interventions to enhance the outcomes and alleviate the quality of care. The recurrence rate of strictures after treatment with internal urethrotomy and direct vision internal urethrotomy by three years is 65%. Other studies reported that the rate of recurrence was estimated to be around 14 after 6 months from internal urethrotomy and up to 27% after 12 months. The rate of complications and recurrence following treatment with anastomotic urethroplasty was estimated to be less than 5%. Detailed information and discussion were provided in the study manuscript.

Female Urethroplasty With Dorsal Onlay Labia Minora Graft: Technical Details and Initial Results.

The objective of this study was to evaluate the functional results of dorsal onlay labia minora graft urethroplasty in the treatment of female urethral strictures. Data were retrospectively examined for 13 patients who underwent augmentation urethroplasty through the dorsal approach using labia minora grafts between September 2017 and January 2019. Demographic, intraoperative, and postoperative data and follow-up conditions were recorded for all patients. The mean age of the patients was calculated as 48.2±7 years. The etiology of urethral strictures was found to be trauma in 2 patients, iatrogenic in 4 patients, and idiopathic causes in 7 patients. The mean urethral stricture length of the patients was 1.5±0.4 cm (range, 1-2.5 cm). The mean surgical duration was 95±11.4 minutes (range, 70-110 minutes). The mean postoperative American Urology Association symptom score, maximum urine flow rate, and postmictional residue values were statistically significantly different compared with preoperative data (P < 0.05). No peroperative and postoperative complications were detected in any patients. The mean follow-up duration of the patients was 19±5.3 months, and no recurrence of stricture was observed in any patients based on the cystourethroscopic examinations. All patients are being followed up in our clinic without any stricture recurrence or symptoms. The dorsal onlay labia minora graft urethroplasty technique in female urethral strictures is an efficient and applicable method with postoperative anatomic and functional results. Studies with longer follow-up periods and larger patient populations are required to present the success and reliability of this technique.

Impact of urethroplasty on male sexual function

PurposeTo evaluate the impact of anterior urethroplasty on male sexual function.Patients and methodsA total number of 35 patients with anterior urethral stricture who underwent urethroplasty at Assiut Urology and Nephrology Hospital from March 2015 to March 2016 were included in the study. The mean age was 36.1 ± 11.1 years (range: 25–56 years). Evaluation of postoperative erectile function was done using a validated questionnaire (International Index of Erectile Function-5 questionnaire) at 3 and 6 months posturethroplasty, while evaluation of ejaculatory and orgasmic function was done by using ejaculation/orgasm score at 3 and 6 months posturethroplasty.ResultsThe mean age of the included patients was 36.1 ± 11.1 years (range: 25–56 years). As regards the incidence of Erectile dysfunction (ED) after urethroplasty, 3 months posturethroplasty, nine (25.7%) patients developed ED, with statistically significant difference (P = 0.001). At 6 months posturethroplasty, just two (5.7%) patients showed ED, with no statistically significant difference (P = 0.15). As regards the incidence of ED according to the etiology of urethral stricture, there was no statistically significant difference between postinflammatory and post-traumatic cases at 3 months (P = 0.636) and at 6 months (P = 0.234). According to the length of urethral stricture, the impact on erectile function after urethroplasty was greater in shorter urethral stricture segment (1.9 ± 0.2 cm) than in longer urethral stricture segment (3.1 ± 1.3 cm) with no statistically significant difference between the two groups (P = 0.514). ED occurred in anastomotic urethroplasty (39.1%) more than free graft urethroplasty (0%), with statistically significant difference (P = 0.012).ConclusionAnterior urethroplasty has a probability of causing transient ED in as much as 25% of patients, with recovery of erectile function occurring in 78% of cases within 6 months of urethroplasty. The incidence of ED is higher in patients undergoing anastomotic repair than in patients undergoing free graft urethroplasty. Urethral reconstructive surgery has a minimal effect on ejaculatory and orgasmic functions.

Transurethral resection of the prostate stricture management.

For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.

Результаты лечения и факторы риска рецидива ятрогенных стриктур уретры у мужчин

Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+/-15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. Average stricture length was 5,8+/-4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length more or equal 5,5 cm. Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods of the US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.

Review on Management of Urethral Stricture Disease at Tertiary Care Centre

Introduction: Urethral stricture disease remains a common cause of morbidity among men. Many questions about the etiology of urethral stricture disease remain unanswered till now. This study was done in a tertiary care center along with a review of the literature to evaluate the etiology of urethral strictures and to determine the factors that may influence possible preventive or curative strategies. Materials and Methods: Data collected from Patients visiting the OPD &amp;/or admitted in the IPD for urethral stricture during the August 2015 to December 2017 this period at tertiary care centre with the help of relevant history, clinical examination, appropriate investigation including and treatment which includes medical and surgical intervention. Results: In study iatrogenic (40%) was main etiological factor for which H/O catheterization was main contributory factor for about 41% among iatrogenic cause. Direct visual internal urethrotomy was common surgical procedure performed with success rate (58%). Anastomotic urethroplasty was associated with success rate of 87.5%. Conclusion: Avoiding unnecessary urethral catheterization and repeated urethral instrumentation can reduce these iatrogenic strictures. Contrast urethrogram was the most common imaging modalities followed by Urethroscopy. Anastomotic urethroplasty had higher success rate as compared to DVIU and Urethral dilatation.

A clinical study of evaluation of different modalities of treatment and etiologies of stricture urethra

Background: Urethral strictures are a common urological problem presenting in day to day urological practice. There has been change in the etiology of urethral strictures with traumatic one’s accounting for majority of them in recent times. Newer treatment modalities like VIU and various kinds of urethroplasty have revolutionized its management and significantly contributed towards improvement of quality of life among these patients. The objective for this study were to study the various aetiologies and different modalities of treatment for urethral strictures.Methods: A 23 cases of urethral strictures aged 5-75 years admitted in the surgical wards of KIMS, Hubballi were included in the present study. Mean age of presentation was 34.5 years. Detailed history and physical examination were recorded. Relevant investigations like ASU and MCU were performed and recorded. These patients were treated by various surgical procedures considered appropriate as per the patient individual needs.Results: Mean age was 34.5 years in the present study. Most of the patients presented with obstructive voiding symptoms, straining (65.1%) and poor stream (56.4%). Majority of strictures were of traumatic etiology (60.8%) followed by inflammatory (34.7%) and iatrogenic strictures (4.3%) in the present study. Bulbar urethra was the most commonly involved site (65.1%) followed by posterior urethra (30.4%), penile urethra (17.4%) and meatal stricture (4.3%). Most of the patients presenting with retention of urine were managed by SPC. Both VIU and urethroplasty had good success rates of 72.7% and 80% respectively.Conclusions: Most of the strictures were of traumatic etiology. VIU and urethroplasty were found to be effective means of treating urethral strictures.

The Management of Urethral Strictures and Stenoses at the John F. Kennedy Medical Center

Background: A urethral stricture is an abnormal narrowing of the urethra resulting from fibrosis in the surrounding corpus spongiosum. The prevalence is estimated to be 229–627 per 100,000 males and its effects on the quality of life of those with the disease are far-reaching. Documented male-to-female ratio in Port-Harcourt, Nigeria, showed a ratio of 31:1 indicating that urethral stricture is very rare in females. Objective: The objective of the study is to assess the approach and outcome of the management of urethral stricture and stenosis at the John F. Kennedy Medical Center. Material and Methods: This is a 7-month retrospective descriptive study assessing the management of 20 patients with urethral stricture at the John F. Kennedy Medical Center from January 2018 to August 2018. The patient’s medical records were retrieved form the record department and reviewed for age, etiology of urethral stricture, site of urethral stricture, procedure performed and postoperative complications. Result: A total of 20 male patients with urethral stricture or stenosis were included in the study. Study revealed that the predominant etiology of urethral stricture was post-traumatic accounting for 35% (7/20). Gonoccal urethritis caused urethral stricture in 30% (6/20) of patients while instrumentation was 20% (4/20). Most of the post-inflammatory stricture involved the bulbar urethra as well as the penile urethra. Urethral Dilatation 9/20 (45%) and resection plus end to end anastomotic urethroplasty 35% (7/20) were the procedures commonly used to manage urethral strictures mostly the bulbar and bulbo-penile parts of the urethra. Conclusion: Urethral stricture disease is a common cause of urological presentation to the urologist worldwide. Urethral dilatation is most commonly performed for urethral strictures due to its feasibility and much less technical challenge. The failure rate is nonetheless high therefore, urethroplasty remains the standard option if possible. Appropriate traffic regulations, judicious use of catheters and proper treatment of urethritis could reduce the incidence of urethral stricture disease.

Imbalance in extracellular matrix degradation in urethral stricture.

BackgroundExtracellular matrix degradation may play an important role in the etiology of urethral stricture. MMP1 and TIMP1 are involved in extracellular matrix degradation. The aim of this study was to investigate the roles of MMP1, TIMP1, and MMP1:TIMP1 ratio at the remodeling phase of urethral stricture in an animal model.MethodsThis research was carried out in collaboration between the Bogor Institute of Agriculture, Universitas Indonesia, and the Eijkman Institute Indonesia. This was an experimental in vivo study in adult male New Zealand rabbits, divided into two groups: a urethral stricture group and a control group. Euthanasia was performed in four rabbits of each group on days 7, 14, 21, 28, and 56. Urethral stricture was confirmed with an 8 F urethral catheter. Several laboratory examinations were done, including H&E and Masson trichrome staining, immunohistochemistry, and ELISA, to determine levels of MMP1 and TIMP1. Percentages of total collagen and collagen type 1 were counted with ImageJ 1.46q software. A general linear model was used for statistic analysis.ResultsWe found that the level of MMP1 was lower, TIMP1 higher, and MMP1:TIMP1 ratio lower in the urethral stricture group than the control group. There was a correlation between MMP1 level with total collagen percentage (r=0.561, P=0.010) and no correlation between TIMP1 and total collagen (r=0.307, P=0.188).ConclusionImbalance in extracellular matrix degradation was marked by decreased MMP1 level and MMP1:TIMP1 ratio and increased TIMP1 level. This results showed that urethral stricture is not only caused by collagen decomposition, but also by the imbalance of extracellular matrix degradation.

Urethral Stricture after Transurethral Resection of Prostate: Role of Maintaining the Temperature of the Urethra with Warm Irrigation Solution

With popularization of transurethral resection of the prostate (TURP), currently, iatrogenic reason is the leading etiology of urethral stricture. Urethral stricture often occurs after TURP, and the triggering factors reported include infection, mechanical injury, and indwelling of the Foley catheter. However, the exact etiology of urethral stricture is still controversial. In our opinion, the temperature in the urethra could be another important factor in stricture formation after TURP. When the body temperature decreases by 1-2°C below the normal temperature, the blood vessels constrict, lessening heat loss to the outside environment. The constriction of blood vessels in the urethra during TURP can also induce ischemic injury in the urethra, resulting in urethral stricture. Warm irrigation and a system to maintain the penis at isothermia during TURP might decrease the incidence of urethral stricture and morbidity. The results of our previous study, entitled “Is warm temperature necessary to prevent urethral stricture in combined transurethral resection and vaporization of prostate?” have shown that maintaining the temperature of the urethra with warm irrigation solution during combined transurethral resection and vaporization of the prostate probably decreases the incidence of urethral stricture. We recommended warm irrigation and a system to maintain the penis at isothermia during TURP to prevent ureteral stricture.

Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon.

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n = 1), urethral dilatation (n = 1), vesicostomy (n = 2), and urethral catheterization (n = 3). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered.

Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases.

Background:Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG) patch.Objective:To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used.Patients and Methods:The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine) mouth wash three times daily beginning from the 2nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded.Results:Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54%) of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2%) had perineal wound infection, while two (18.2%) still had mild pain at donor site 4 weeks postoperatively. Ten (90.9%) of the 11 patients had <30 ml residual urine volume at 2 months of follow-up.Conclusion:Urethritis is still a common cause of urethral stricture in this rural community. Ventral onlay buccal mucosal graft urethroplasty for proximal bulbar urethral stricture is safe, even in certain adverse preoperative conditions. Buccal mucosa from the cheek is however now preferred.

Incidence, Causes, and Complications of Urethral Stricture Disease

Urethral stricture refers to any narrowing of the urethra, independent of whether it affects the flow of urine out of the bladder. Urethral stricture occurs mainly in men, and the disease is a common and challenging urologic condition. The real incidence of male urethral stricture disease remains unknown, and worldwide differences have been observed based on geography, population, and mean country income. The number of patients with urethral strictures climbs sharply after 55 yr of age in the Western population. The main causes of urethral strictures consist of congenital anomalies of the mucosal membrane, infection, traumatic scarring after blunt pelviperineal trauma, urethral instrumentation, catheterisation, hypospadias failures, and inflammatory disease of the corpus spongiosum caused by lichen sclerosus. Idiopathic and iatrogenic aetiology are the main causes of urethral strictures in developed countries. Trauma remains the most common aetiology of urethral strictures in developing and Third World countries. About 90% of men with urethral stricture disease present complications. The management of urethral stricture disease may result in complications. The main direct complications of urethral surgery are bleeding, infection, incontinence, impotence, and stricture recurrence. Patient summaryUrethral stricture is a common urologic disease affecting men. Urethral strictures result in lower urinary tract symptoms and affect quality of life. Perineal trauma, long-term urethral catheterisation, urologic instrumentation, chronic inflammatory disorders such as lichen sclerosis, and sexually transmitted diseases are typical causes.

Comprehensive analysis of etiology on the prognosis of urethral strictures

Urethral strictures remain a reconstructive dilemma, due to high incidence of recurrence and less than satisfactory outcomes. Even experienced surgeons following strict surgical principles have not achieved optimal results, leading us to think whether the etiology of strictures dictate the outcome . We evaluated this "cause-effect" relationship highlighting the significance of the etiology on the overall prognosis of urethral strictures. A total of 302 males with urethral strictures were assessed (both retrospectively and prospectively) over a period of ten years. The preoperative evaluation was performed by retrograde urethrogram, urethrosonogram, and uroflowmetry and categorized, based on etiology: a) as post traumatic, b) post infective, c) iatrogenic or d) unknown. Traumatic strictures were subjected to pelvic X-ray and sub-categorized into grades A, B and C, following the TILE classification. Patients were operated; with tunica albuginea urethroplasty for anterior strictures and U shape prostato-bulbar anastomosis for posterior strictures. Traumatic strictures accounted for 54% of cases. 127 of the 302 patients were treated using Tunica Albuginea Urethroplasty, while U shaped Prostatobulbar Anastomosis was performed on others. Post traumatic strictures had best outcome whereas post infective strictures had the worse outcome. Among strictures following pelvic fractures, TILE grades A and B had a better post operative course as compared to TILE C. Overall complication rate was 13.24%. Our study demonstrated that etiology of urethral strictures may play a vital role for the overall prognosis of urethral strictures.