This document discusses the role of minimally invasive techniques in the management of urethral strictures. It outlines the "reconstructive ladder" approach, starting with the simplest procedures like dilation and direct visual internal urethrotomy (DVIU) and progressing to more complex approaches if needed. DVIU is described as being used for short, non-obliterative strictures but having high recurrence rates. Other minimally invasive options discussed include laser urethrotomy, urethral stents, and primary urethral realignment, with each having specific indications and limitations. Delayed formal urethroplasty is presented as the preferred treatment for posterior urethral distraction

1. Role of Minimally Invasive Techniques
in Management of Stricture Urethra
Amr Elkady, MD
Lecturer of Urology
Kasr Al Aini Faculty of Medicine
Cairo University

2. Role of Minimally Invasive Techniques
in Management of Stricture Urethra
Minimally invasive
techniques
Conventional open
Surgeryvs

3. • Reconstructive ladder
Simplest procedure
Role of Minimally Invasive Techniques
in Management of Stricture Urethra
Repeated after failure
More complex
approaches

4. Patient Physician
Simple Procedure Complex Procedure
Role of Minimally Invasive Techniques
in Management of Stricture Urethra
stricture recurrence stricture recurrence

5. • Dilatation
• DVIU
• Laser urethroromy
• Urethral stents
• Primary Urethral realignment
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

6. Urethral dilatation
• Oldest and simplest
• The goal of this treatment is to stretch the
scar without producing more scarring
• Urethral balloon-dilating catheters
• ?? Post urethroplasty
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

7. DVIU (Direct Visual Internal
Urethrotomy)
Technique
 ureteric catheter
 single incision at the 12 o’clock
 incision through the scar to healthy
tissue
 Catheter 2 – 7 days
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

8. DVIU (Direct Visual Internal Urethrotomy)
Indications
 short non-oblitrative strictures
 Absence of spongiofibrosis
How many times???
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

9. DVIU (Direct Visual Internal
Urethrotomy)
Wound contracture vs epithelialization
 Catheter 6 weeks ??
 Home self-catheterization
 Home urethral obturation
 Colchicine
 Mitomycin C
Urethral stents
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

10. DVIU (Direct Visual Internal Urethrotomy)
Complications
 Recurrence
 Bleeding
 Erectile dysfunction
Role of Minimally Invasive Techniques
in Management of Stricture Urethra
Rare

11. DVIU (Direct Visual Internal
Urethrotomy)
Does it affect subsequent
urethroplasty?
Cut to the light
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

12. Laser Urethrotomy
Laser vs conventional cold knife urethrotomy
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

13. Urethral stents
• short strictures of the bulbous urethra
associated with minimal spongiofibrosis ??
• Pain
• Contraindicated with Skin flap urethroplasty
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

14. • Primary Urethral Realignment
What is primary realignment?
Technique
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

15. • Primary Urethral
Realignment
Role of Minimally Invasive Techniques
in Management of Stricture Urethra
No. of patients Stricture rate %
Moudouni et al, 2001 29 41%
Salehipour et al, 2005 25 24%
Mouraviev et al., 2005 57 49%
Leddy et al., 2012 19 79%
Gomez et al., 2013 18 83%
Pompeo et al., 2013 18 56%
Our study 18 56%

16. • Primary Urethral Realignment
 Feasibility
 Benefits:
- stricture rate
- stricture severity
- subsequent urethroplasty
 Continence and Potency
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

17. • Delayed formal urethroplasty is the
procedure of choice for the treatment
of posterior urethral distraction defects.
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

18. • Cold knife or laser core-through or cut-to-the
light urethrotomy for complete urethral
obliteration has been described with poor
results and the procedure is therefore not
recommended.
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

19. • Internal urethrotomy  short and non-
obliterative
• Anastomotic urethroplasty
 long and dense complete obliteration
 after failed internal urethrotomy
Role of Minimally Invasive Techniques
in Management of Stricture Urethra

20. We should choose what is the best for the patient
not what we can do better
Spongiofibrosis
Repeated Urethrotomies
Role of Minimally Invasive Techniques
in Management of Stricture Urethra