Many men with a stricture will have increasing discomfort with urinating and a slowing of the urinary stream. The anatomy is important here because male urethral strictures differ in etiology, diagnosis, and management based upon stricture locations. We retrospectively identified female urethral strictures from 1998 to 2010. Strength of recommendations is stratified according to letter grade that. Cutting the stricture with a endoscopic equipment urethrotomy and surgical repair of the stricture with reconnection and reconstruction called urethroplasty. Dilation needs to be repeated either daily or on alternate. Management of anterior urethral strictures european. Questionnaire and response a questionnaire on diagnosis, treatment, and followup of male anterior. Management of urethral stricture in women request pdf. What data there are come largely from so called expert opinion and the quality of this is variable. Urethral stricture involves constriction of the urethra. It is our observation that dilation is an overused management option, because patients with urethral stricture disease are often treated with dilation when they can be cured with a properly performed urethroplasty.
Urethral stents where a biocompatible hollow tube is placed on the inside of the stricture to allow for free passage of urine. Urethral stricture guideline american urological association. Urethral stricture disease is one of the commonest conditions encountered by urologists in the indian subcontinent. Management of adult anterior urethral stricture disease. Various methods have been used to improve the results, e. Urethral stricturetreatmentexerciseprognosiscauses. Thus for most people with urethral stricture disease, dilatation or urethrotomy are palliative management rather than curative treatment. There is significant variability in clinical practice for the treatment of urethral stricture.
Management of urethral stricturesstenosis is complex and requires careful evaluation. Overview covers causes, incidence, risk factors, symptoms, treatment, complications and prevention. The prevalence of urethral stricture is estimated to be 0. Dilation dilation was known to ancient civilizations. It was considered the standard treatment for managing strictures of the urethra over centuries. Anterior urethral reconstruction key points may initially treat meatal or fossa navicularis stricture with dilation or meatotomy should offer urethroplasty for recurrent meatal of f. Management of longsegment and panurethral stricture disease. Management of urethral strictures stenosis is complex and requires careful evaluation. Many urologists erroneously believe that there is a reconstructive ladder and that urethroplasty is considered only after successive failed dilations or. Study inclusion criteria were 1 clinical diagnosis of stricture, 2 stricture seen on cystoscopy, 3 urethral obstruction on videourodynamics according to the blaivas.
Rates of stenosis after prostate cancer treatment appear similar across all primary treatment modalities including radical prostatectomy. These conditions greatly impact the health and quality of life of patients. According to the results of a nationwide survey, direct vision internal urethrotomy dviu is used for most urethral strictures in the united states and the situation is similar in korea. The anterior urethral stricture is an organic narrowing of the urethra caused by scarring of the urethral. The male urethra is divided into two major segments. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this.
Urethral stricture stenosis is a narrowing of the urethral lumen. Management of longsegment urethral stricture remains a challenge in reconstructive urology. American urological association male urethral stricture introduction purpose urethral stricture is chronic fibrosis and narrowing of the urethral lumen caused by acute injury, inflammatory conditions, and iatrogenic interventions including urethral instrumentation or surgery and prostate cancer treatment. From urethral stricture causes and urethral stricture symptoms, to urethral stricture treatments, well give you the basics of urethral stricture so that you will be prepared if it happens to you.
Urethral stricture is the term applied to abnormal narrowing of the anterior urethra, whereas the american urologic association prefers the term stenosis for narrowing of the posterior urethra, which lacks spongiosum. Anterior urethral strictures affect the male urethra between the tip of the penis and the apex of the prostate. Male urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. A urethral stricture is a narrowing of the urethra, the tube through which urine leaves the bladder and exits the body. Pdf advances in urethral stricture management semantic. The surgical treatment of urethral strictures varies according to etiology, location, length, and density of the lesion and fibrosis involving surrounding tissues. A urethral stricture is a narrowing of the urethra caused by injury, instrumentation, infection, and certain noninfectious forms of urethritis. This narrowing often causes difficulty with passing urine, including straining and pain in the urethra. Clinicians planning nonurgent intervention for a known stricture should determine the length and location of the urethral stricture. The aim dilation is to stretch the scar without bleeding so the narrow urethral lumen is stretched temporarily and the patient can void well. Management of urethral strictures postgraduate medical.
Male urethral stricture disease is prevalent and has a substantial impact on quality of life and healthcare costs. The clinical guideline on male urethral stricture provides a clinical framework for the diagnosis of urethral stricture and includes discussion of diagnosis and initial management, urethroplasty, reconstruction, contracture, stenosis, special circumstances, and postoperative followup care. The bucccal mucosal graftbmg may as well be the new gold standard in the management of anterior urethral stricture. Surgeons may utilize urethral endoscopic management e. Advances in urethral stricture management fresearch. Management of urethral strictures is complex and depends on the characteristics.
Your urethra is the tube that carries urine from the bladder through the penis and out the urethral meatus the opening at the tip of the penis during urination. Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor costeffective. Urethral stricture in men management and treatment. Balloon dilation performs poorly as a salvage management.
The burden of disease from urethral strictures is expected to increase with time. In some cases, the urethra is reconstructed by removing the scar tissue and then suturing the ends of the urethra back together, called an urethroplasty. Controlled clinical trials are unusual in surgery, rare in urology, and almost nonexistent as far as the management of urethral stricture is concerned. Essentially, a urethral stricture is a constriction within your urethra, the thin tube that. Patients with urethral stricture disease experience bothersome luts, recurrent infections and haematuria and often undergo multiple endourological procedures 2.
This article discusses the incidence, evaluation, and treatment of bladder outlet obstruction from urethral stricture, vesicourethral anastomotic stricture, and bladder neck contracture following primary and salvage treatment of prostate cancer. Some of the other causes for urethral stricture are pelvic fractures, insertion of catheters, radiation therapy, or prostate surgery. Male urethral reconstruction and the management of. Though there has been a recent interest in urethroplasty, most urologists still prefer minimally invasive methods of treatment like endoscopic urethrotomy or urethral dilatation. Urethral stricturestenosis is a narrowing of the urethral lumen.
Direct vision balloon dilation for the management of. To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. The common causes for urethral strictures seem to be idiopathic or related to. Advances in urethral stricture management version 1. This condition occurs in up to 600 out of every 100,000 men, 2. Weiss from the state university of new york downstate medical center jgb, jft, rsp, jpw, brooklyn, and weill cornell college of medicine. For these reasons, the american urological association aua 2016 guideline on male usd states that surgeons may offer any of the abovestated techniques for the initial management of a short urethral stricture provides a clinical framework for the diagnosis of urethral stricture and includes discussion of diagnosis and initial management, urethroplasty, reconstruction, contracture, stenosis, special circumstances, and postoperative followup care. Pdf management of anterior urethral strictures kumar. Management of urethral stricture in women sciencedirect.
None the less, the number of so called experts, past and present, is comparatively small and in broad principle their views more or less. Urethral stricture disease is associated with varying degrees of fibrosis of the spongiosum. It appears to provide the solution for most situations in the anterior urethral stricture conclusions. Trends in urethral stricture management over two decades. Management of urethral strictures urethral strictures. We are in no way suggesting that direct vision balloon dilation may offer a higher cure rate than other dilation methods. Jeremy myers from the university of utah explains the types of surgeries that are done for urethral stricture disease. A straddle injury is caused due to being hit around the scrotum or falling directly on bicycle bar. If dilation or urethrotomy fails and the stricture returns, urethral reconstruction may be needed to obtain a durable result in terms of opening the urethra. The management of urethral stricture in women includes urethral dilatation, urethrotomy, clean isc and substitution urethroplasty 10,15.