Viruses Treatment Articles

Urethral Stricture Tips

May 15, 2017

UroToday - Urologists in practice will likely be confronted with bulbous urethral stricture disease. Certainly there will be other patients who present to the office, but most of the techniques for dealing with strictures, other than in the bulbous urethra, are more than the general urologist in practice may want to tackle. However, there are strictures of the bulbous urethra which can be addressed without too much difficulty by the urologist who sees a fair number of strictures in his practice, and who is motivated to proceed with reconstruction. The most common error in addressing strictures of the bulbous urethra is to misinterpret the extent of spongiofibrosis. If one has a narrow caliber segment in the bulbous urethra, even if the urethra proximal to that narrow caliber segment appears to be of adequate caliber, it indeed may also be involved with the process of spongiofibrosis, and when the hydrodilation of the narrow caliber portion of the stricture is relieved, the proximal urethra will then go on to tighten down and the urologist will be faced with a recurrence of stricture. Thus the evaluation of the length of spongiofibrosis is crucial to the success of any procedure to address it.

There is ample literature which states that dilation and internal urethrotomy have a distinct place in the management of bulbous urethral stricture disease. There is also literature which states that not every patient with bulbous stricture disease deserves to have dilation or an internal urethrotomy.

The literature is relatively uniform in stating that the patient who may enjoy success from an internal urethrotomy or dilation with curative intent will have a short segment stricture (1 to 1 1⁄2 cm.), will have relatively superficial spongiofibrosis, and the stricture will be located in the bulbous urethra. The success rate for internal urethrotomy and dilation for strictures other than in the bulbous urethra is dismally poor. There is also ample literature which states that repetitive dilation and internal urethrotomy never proceed to cure, but they certainly proceed to spreading the stricture disease, making reconstruction more difficult, and making the results of subsequent reconstruction less than they would have been should the stricture have been addressed initially.

With regards to open reconstruction, the excision of the stricture and primary anastomosis has been declared, and rightfully so, the gold standard. Its limitation is that excision and primary anastomosis does consume a length of bulbous corpus spongiosum, and when one tries to address strictures that are too long, one risks the creation of chordee and/or penile shortening.

Certain techniques which allow for the extended use of excision with primary anastomosis will be addressed. Likewise the technique of vessel sparing, excision and primary anastomosis for very proximal bulbous strictures will be reviewed.

Certainly not all strictures can be addressed with excision and primary anastomosis, and techniques of tissue transfer will be addressed. The behavior of graft and flaps, the techniques of transfer, and the expectations of the unit of transfer will be covered in some detail. Cases will be used to illustrate current techniques of graft and flap onlay, and graft and flap augmented anastomosis.

Presented by: Gerald H. Jordan, MD, FACS, FAAP, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda.

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