Management of

Anterior urethral stricturesAUA update series 2014

Summarized By

Mohammed T. Doukhi

MD,

Technology Jordan university of Science &

outlines

◦ Introdution

◦ Epidemiology and etiology

◦ Diagnosis

◦ Treatment

◦ Complication

◦ Conclusion

introduction

Definition :

It is narrowing of the anterior urethral that

impedes flow and implies some degree of

spongiofibrosis is called stricture

Epidemilogy and etiology

Common in men

Older than 65 years old

Most common is idiopathic

2nd most common is iatrogenic

Ex. Cath,cystoscopy,TURP.

lichen sclerosus (PXO)

Diagnosis

Urethral stricture typically present with obstructive voiding symptoms

Such as Weak stream

Incomplete voiding

Cystitis

Bladder stone

Hydronephrosis and renal failure (rare)

Inability to pass catheter in a patient otherwise asymptomatic

Investigation

RUG

MCUG

U/S

MRI

Treatment

:Urethral dilationUsing balloon dilator after placement of guidewire

under direct visualization to minimize the risk of

creating a false passage or rectal injury

Internal urethrotomy:

Using a cold-knife incision at 12 o’clock position

Foley catheter is left in place for 3 to 5 days

Cont, Treatment

Many believe that urethrotomy is more effective than

dilator,

randomized clinical trial of dilation vs. urethrotomy

revealed NO long-term difference in outcome.

Alternative technique such as resection the scar or

use of laser have not provide increase efficacy

Disadvantage of dilator and urethrotomy :

No benefit if

Stricture larger than 1 cm

Stricture in penile urethra

Intraurethral stents :

Intraurethral stents :

Cont, Treatment

Intraurethral stents :Have been used to treat strictures.

Designed for incorporation into urethral mucosa

which appear to work best for short bulbar stricture.

Stent migration and re-stricture were reported

following insertion leading to more difficult

urethroplasty

is no longer available in the U.S.A®The Urolume

Cont, Treatmet

:UrothroplastyBased in the location and caliber of the stricture,

urethroplasty can be performed either by excision of

the stricure with reanastomosis, or with graft or flap

Stricture within the penile urethra are rarely excised

because shortening the urethra may lead to penile

curvature.

Complications

Urethral dilation may lead to hematuria, false

passage and, rarely bladder perforation and rectal

injury

Urethrotomy may result in hematuria and false

passage. Epididymitis, prostatitis, penile curvature

and glans necrosis have also been reported

Immediate complication after

urethroplasty are uncommon but include

infection bleeding and thromboembolism

Cont, Complications

If urethroplasty is performed with the patient in high

lithotomy position, surgery for longer than 5 hours

has been associated with complications such as

neuropraxia, compartment syndrome and

rhabdomyolysis

Long-term:Restricture rate after excision and primary

anastomosis is 10% at 10 years

Recurrence rate after graft or flap reconstrution are

approximately 20%

Cont, Complications

it is not uncommon for patient to report erectile

dysfunction after urethroplasty but recovery generally

occure by 6 month

Conclusion

Stricture of anterior urethra is typically present with

obstructive voiding symptoms

And more frequently associated with iatrogenic

trauma. Retrograde urethrography is the most useful

technique for diagnosis the location of the stricture.

Minimally invasive option such as dilation or

urethrotomy should be limited to short strictures

within bulbar urethra. Urethroplasty with excision and

primary anastomosis has the best success rates and

should be performed when possible. For strictures

that are too long for primary anastomosis

urethroplasty may be performed using grafts or flaps.