Korean J Urol.  2013 Sep;54(9):561-569.

Current Management of Urethral Stricture

• Lee YJ
• Kim SW

Abstract

The surgical treatment of urethral stricture diseases is continually evolving. Although various surgical techniques are available for the treatment of anterior urethral stricture, no one technique has been identified as the method of choice. This article provides a brief updated review of the surgical options for the management of different sites and different types of anterior urethral stricture. This review also covers present controversies in urethral reconstruction. Among the various procedures available for treating urethral stricture, one-stage buccal mucosal graft urethroplasty is currently widely used. The choice of technique for urethroplasty for an individual case largely depends on the expertise of the surgeon. Therefore, urologists working in this field should keep themselves updated on the numerous surgical techniques to deal with any condition of the urethra that might surface at the time of surgery.

Keyword

Urethra; Urethral stricture; Urethroplasty

MeSH Terms

Transplants
Urethra
Urethral Stricture

Figure

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  FIG. 1 Representative retrograde urethrography. (A) Preoperative retrograde urethrography in a patient with a short bulbar urethral stricture following straddle injury. (B) Normal retrograde urography 2 weeks after excision and end-to-end anastomosis.

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  FIG. 2 Intraoperative picture of a substitution urethroplasty with ventral onlay buccal mucosal graft (BMG). (A) The corpus spongiosum is opened along ventral surface and the urethral lumen is fully exposed proximally and distally to the stricture. Then the length and width of the BMG required for the augmentation are measured. (B) BMG is trimmed to its appropriate size and the two ends of the graft are sutured to the proximal and distal end of the urethrotomy. Running suture is used to complete a watertight anastomosis between the right margin of the BMG and the right margin of the urethral mucosal plate. (C) The graft is rotated over the catheter and a running suture is completed on the opposite margin of the graft and the urethral mucosa. (D) The spongiosum is closed over the BMG using interrupted sutures.

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  FIG. 3 Retrograde urethrographic appearance before (A) and after (B) surgery in the same patient (Fig. 2).

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  FIG. 4 Intraoperative picture of augmented nontransected anastomotic urethroplasty. (A) Bulbar urethra after ventral urethrotomy. Narrowest portion of the stricture is observed. (B) Incision through the mucosa and resection of the diseased mucosa (arrows) and scarred portion of the spongiosum. (C) Reanastomosis of the mucosa layer (arrows). (D) Ventral placement of the BMG to augment the urethral lumen.

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  FIG. 5 Retrograde urethrographic appearance before (A) and after (B) surgery in the same patient (Fig. 4).

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  FIG. 6 Intraoperative picture of Orandi procedure. (A) Penile urethra after ventral urethrotomy. (B) An appropriate length and width of penile skin is designed. (C) Penile skin is mobilized on a dartos pedicle. (D) The free margin of the skin is sutured to the near margin of the urethra and the skin flap is flipped over and the dartos margin is then sutured to the other margin of the urethra.

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  FIG. 7 Staged urethroplasty with full-thickness skin graft in a man with previous pediatric hypospadias repair. (A) Appearance of penile skin. Multiple scars are visible. (B) Urethral plate is preserved. (C) Full-thickness hairless groin skin is used. (D) After 4 months, inlay graft has excellent incorporation with urethral plate. (E) Stage 2 urethroplasty is completed.

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