2. Urethral Stricture Disease
• Definition: Scarring process of the anterior
urethral epithelium and/or spongy erectile
tissue of the corpus spongiosum.
4. Risk Factors
• Any process that injures the urethral epithelium
▫ Trauma
Straddle Injury
▫ Iatrogenic
Catheter placement
TURP
▫ Infection
Gonorrhea/Chlamydia
Lichen Sclerosis (BXO)
▫ Most patients will have no obvious etiology (50%)
10. • <50% success with DVIU4
▫ Longer strictures
▫ Dense spongiofibrosis
▫ Prior DVIU
• Most cost-effective strategy is DVIU then
urethroplasty
▫ Tailor based on above risk factors for failure
11. Urolume Placement5
• 5 year success – 60-70%5
• Failure – catastrophic
• DO NOT place these in the
anterior urethra
25. Case #2
• 67 M undergoing spinal surgery – unable to
place foley catheter
▫ Urology consulted – cystoscopy performed, unable
to place wire into bladder b/c of urethral stricture
▫ SP tube placed
26. Case #2
• Lumen size estimated to be
around 8-10 F
• Length – 3 to 4 cm
• Options?
▫ EPA
▫ Graft
▫ Flap
43. Case #4
• 56 M with BPH, underwent TURP and now
with post-op LUTS.
▫ Uroflowmetry – max flow rate 5.5 mL/sec,
obstructive pattern
▫ Cystoscopy – narrowing at penoscrotal
junction, unable to pass cystoscope
▫ SP tube placed
▫ RUG
61. Post-treatment monitoring
• Foley catheter for 3 weeks
• VCUG – replace if extravasation seen
• RUG/VCUG at 3 and 12 months (or cystoscopy)
• Uroflowmetry at every visit
• Repeat cystoscopy:
▫ UTI
▫ Elevated PVR
▫ Worsening symptoms
▫ Worsening uroflowmetry
62. Current controversies
• Underutilization of urethroplasty
• DVIU versus immediate urethroplasty
• Limits of anastomotic repairs
• Sexual dysfunction after urethroplasty
• Tissue engineering
• Long-term outcomes of flaps/grafts
