Management of Anterior urethral stricturesAUA update series 2014 Introdution Epidemiology and etiology Diagnosis Treatment Complication Conclusion

1. Management of
Anterior urethral strictures
AUA update series 2014
Summarized By
Mohammed T. Doukhi
MD,
TechnologyJordan university of Science &

2. outlines
◦ Introdution
◦ Epidemiology and etiology
◦ Diagnosis
◦ Treatment
◦ Complication
◦ Conclusion

3. introduction
Definition :
It is narrowing of the anterior urethral that
impedes flow and implies some degree of
spongiofibrosis is called stricture

4. 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)

5. 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

6. Investigation
 RUG
 MCUG
 U/S
 MRI

12. Treatment
:Urethral dilation
Using 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

13. 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

14. Intraurethral stents :

15. Intraurethral stents :

16. 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

19. Cont, Treatmet
:Urothroplasty
Based 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.

21. 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

22. 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%

23. Cont, Complications
it is not uncommon for patient to report erectile
dysfunction after urethroplasty but recovery generally
occure by 6 month

24. 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.