The document discusses urethral stricture, which refers to scarring in the urethra that narrows the passageway for urine. It describes the anatomy of the male urethra and its divisions. Common causes of urethral stricture include trauma, infections like gonorrhea, prolonged catheterization, and complications after surgery. Left untreated, stricture can lead to urinary retention, infections, kidney damage from back pressure, and fistula formation. Symptoms include weak urinary stream and sudden retention.

1. 11
Dr sumer yadavDr sumer yadav

2. 22
DEFINITIONDEFINITION
THE TERM URETHRALTHE TERM URETHRAL
STRICTURE GENERALLY REFERSTRICTURE GENERALLY REFER
TO ANTERIOR URETHRALTO ANTERIOR URETHRAL
DISEASE OR A SCARRINGDISEASE OR A SCARRING
PROCESS INVOLVING THEPROCESS INVOLVING THE
SPONGY ERECTILE TISSUE OFSPONGY ERECTILE TISSUE OF
CORPUS SPONGIOSUMCORPUS SPONGIOSUM
(SPONGIO FIBROSIS)(SPONGIO FIBROSIS)

3. 33
ANATOMYANATOMY
MALE URETHRAMALE URETHRA
 18-20 CM. LONG18-20 CM. LONG
 EXTEND FROM INTERNAL URETHRALEXTEND FROM INTERNAL URETHRAL
ORIFICE IN THE NECK OF BLADDER TOORIFICE IN THE NECK OF BLADDER TO
EXTERNAL URETHRAL ORIFICE AT TIP OFEXTERNAL URETHRAL ORIFICE AT TIP OF
PENIS.PENIS.
URETHRA IS DIVIDED INTO ANT AND POSTURETHRA IS DIVIDED INTO ANT AND POST
SEGMENT.SEGMENT.
 ANT URETHRAANT URETHRA ––
 MEATUS, FOSSANAVICULARIS, PENILEMEATUS, FOSSANAVICULARIS, PENILE
URETHRA & BULBAR URETHRA.URETHRA & BULBAR URETHRA.
 POST URETHRAPOST URETHRA ––
 THE MEMBRANOUS URETHRA & THE PROSTATICTHE MEMBRANOUS URETHRA & THE PROSTATIC
URETHRA.URETHRA.

4. 44

5. 55
PROSTATIC URETHRAPROSTATIC URETHRA
3CM. IN LENGTH3CM. IN LENGTH
WIDEST AND MOSTWIDEST AND MOST
DILATABLE PART OFDILATABLE PART OF
URETHRA.URETHRA.
IT LIES NEARER THE ANTIT LIES NEARER THE ANT
SURFACE THAN THE POSTSURFACE THAN THE POST
SURFACE OF PROSTATE.SURFACE OF PROSTATE.

6. 66
PROSTATIC URETHRAPROSTATIC URETHRA
 ON THE POST WALL THERE IS A MEDIANON THE POST WALL THERE IS A MEDIAN
LONGITUDINAL RIDGE OF MUCOUSLONGITUDINAL RIDGE OF MUCOUS
MEMBRANE K/a URETHRAL CREST &MEMBRANE K/a URETHRAL CREST &
EACH SIDE OF CREST SHALLOWEACH SIDE OF CREST SHALLOW
DEPRESSION TERMED AS PROSTATICDEPRESSION TERMED AS PROSTATIC
SINUS.SINUS.
 AT MIDDLE PART OF THE URETHRALAT MIDDLE PART OF THE URETHRAL
CREST THERE IS ROUNDED ELEVATIONCREST THERE IS ROUNDED ELEVATION
CALLED VERUMONTANUM WHICH MARKCALLED VERUMONTANUM WHICH MARK
THE POSITION OF EXTERNAL SPHINCTERTHE POSITION OF EXTERNAL SPHINCTER
AND MOST IMPORTANT LANDMARK INAND MOST IMPORTANT LANDMARK IN
TRUP.TRUP.

7. 77

8. 88
MEMBRANOUS PARTMEMBRANOUS PART
 1-2CM IN LENGTH1-2CM IN LENGTH
 SHORTEST & LEAST DILATABLESHORTEST & LEAST DILATABLE
PARTPART
 SURROUNDED BY FIBRES OFSURROUNDED BY FIBRES OF
EXTERNAL SPHINCTER URETHRA.EXTERNAL SPHINCTER URETHRA.
 PERFORATES THE PERINEALPERFORATES THE PERINEAL
MEMBRANE AFTER WHICH ITMEMBRANE AFTER WHICH IT
BECOMES SPONGY URETHRABECOMES SPONGY URETHRA
ABOUT 1 INCH BELOW AND BEHINDABOUT 1 INCH BELOW AND BEHIND
THE SYMPHYSIS PUBIS.THE SYMPHYSIS PUBIS.

9. 99
SPONGY (PENILE) PARTSPONGY (PENILE) PART
 15CM. LONG15CM. LONG
 PASSES THROUGH THE BULB ANDPASSES THROUGH THE BULB AND
CORPUS SPONGIO SUM OF THECORPUS SPONGIO SUM OF THE
PENIS.PENIS.
 NARROW WITH UNIFORM DIA. OFNARROW WITH UNIFORM DIA. OF
6MM IN BODY OF PENIS BUT IT6MM IN BODY OF PENIS BUT IT
DILATED IN BULB TO FORMDILATED IN BULB TO FORM
INTRABULBER FOSSA AND ININTRABULBER FOSSA AND IN
GLANS IT FORMS NAVICULARGLANS IT FORMS NAVICULAR
FOSSA.FOSSA.

10. 1010
SPHINCTERS OF URETHRASPHINCTERS OF URETHRA
INTERNAL URETHRAL SPHINCTERINTERNAL URETHRAL SPHINCTER
 EXTERNAL URETHRAL SPHINCTEREXTERNAL URETHRAL SPHINCTER
INTERNAL URETHRAL SPHINCTERINTERNAL URETHRAL SPHINCTER
 MADE UP OF SMOOTH MUSCLE FIBRESMADE UP OF SMOOTH MUSCLE FIBRES
 INVOLUNTARY IN NATUREINVOLUNTARY IN NATURE
 SUPPLIED BY SYMPATHETIC NERVESSUPPLIED BY SYMPATHETIC NERVES
TT1111, T, T1212, L, L11, L, L22
 IT CONTROLS THE NECK OF BLADDERIT CONTROLS THE NECK OF BLADDER
AND PROSTATIC URETHRA ABOVE THEAND PROSTATIC URETHRA ABOVE THE
OPENING OF EJACULATORY DUCTS.OPENING OF EJACULATORY DUCTS.

11. 1111
SPHINCTER OF URETHRA (Cont.)SPHINCTER OF URETHRA (Cont.)
EXTERNAL URETHRAL SPHINCTEREXTERNAL URETHRAL SPHINCTER
 MADE UP OF STRIATED MUSCLEMADE UP OF STRIATED MUSCLE
 VOLUNTARY IN NATUREVOLUNTARY IN NATURE
 SUPPLIED BY PERINEAL BRANCHSUPPLIED BY PERINEAL BRANCH
OF PUDENDAL NERVE SOF PUDENDAL NERVE S22, S, S33, S, S44..
 CONTROLS THE MEMBRANOUSCONTROLS THE MEMBRANOUS
URETHRA AND RESPONSIBLE FORURETHRA AND RESPONSIBLE FOR
VOLUNTARY HOLDING OF URINE.VOLUNTARY HOLDING OF URINE.

12. 1212
DEVELOPMENTDEVELOPMENT

13. 1313

14. 1414
ETIOLOGYETIOLOGY
ANY PROCESS THAT INJURESANY PROCESS THAT INJURES
THE URETHRAL EPITHELIUM ORTHE URETHRAL EPITHELIUM OR
THE UNDERLYING SPONGIOSUMTHE UNDERLYING SPONGIOSUM
TO THE POINT THAT HEALINGTO THE POINT THAT HEALING
RESULTS IN A SCAR, CANRESULTS IN A SCAR, CAN
CAUSE AN ANT URETHRALCAUSE AN ANT URETHRAL
STRICTURE.STRICTURE.

15. 1515
 COMMON SITES ARECOMMON SITES ARE
 EXTERNAL MEATUSEXTERNAL MEATUS
 PENO SCROTAL JUNCTIONPENO SCROTAL JUNCTION
 CONGENITAL STRICTURE MAY RESULTS INCONGENITAL STRICTURE MAY RESULTS IN
SEVERE BACK PRESSURE ON URINARYSEVERE BACK PRESSURE ON URINARY
TRACT LEADING TO HYPERTROPY OFTRACT LEADING TO HYPERTROPY OF
DEXTRUSOR MUSCLE, URETERO VESICALDEXTRUSOR MUSCLE, URETERO VESICAL
REFLUX, HYDRONEPHRROSIS,REFLUX, HYDRONEPHRROSIS,
HYDROURETER & RENAL FAILUREHYDROURETER & RENAL FAILURE
 TO AVOID ALL THESE COMPLICATIONSTO AVOID ALL THESE COMPLICATIONS
PRELIMINARY SUPRAPUBIC DRAINAGE MAYPRELIMINARY SUPRAPUBIC DRAINAGE MAY
BE REQUIRED.BE REQUIRED.
CONGENITALCONGENITAL

16. 1616
INSTRUMENTALINSTRUMENTAL
 CYSTOSCOPY INCYSTOSCOPY IN
INEXPERIENCED HANDINEXPERIENCED HAND
 PASSAGE OF TOO LARGE SIZEPASSAGE OF TOO LARGE SIZE
ENDOSCOPEENDOSCOPE
 INDWELLING CATHETER FORINDWELLING CATHETER FOR
PROLONGED PERIODPROLONGED PERIOD

17. 1717
POST OPERATIVEPOST OPERATIVE
 PROSTATECTOMY: - POST OPERATIVEPROSTATECTOMY: - POST OPERATIVE
STRICTURE DEVELOPS AFTER ABOUTSTRICTURE DEVELOPS AFTER ABOUT
4% OF PROSTATECTOMY4% OF PROSTATECTOMY
IRRESPECTIVE OF THE METHODIRRESPECTIVE OF THE METHOD
EMPLOYED.EMPLOYED.
 STRICTURE IS PRESENT USUALLY INSTRICTURE IS PRESENT USUALLY IN
PROXIMAL PART OF URETHRA AND K/aPROXIMAL PART OF URETHRA AND K/a
BLADDER NECK STENOSIS WHICH ISBLADDER NECK STENOSIS WHICH IS
TREATED BY TUI-R.TREATED BY TUI-R.
 AMPUTATION OF PENIS – STRICTUREAMPUTATION OF PENIS – STRICTURE
FORMATION IS ALSO A COMPLICATIONFORMATION IS ALSO A COMPLICATION
OF PARTIAL AND COMPLETEOF PARTIAL AND COMPLETE
AMPUTATION OF PENIS.AMPUTATION OF PENIS.

18. 1818
INFLAMMATORYINFLAMMATORY
GONORRHEAGONORRHEA
NON SPECIFIC URETHRITISNON SPECIFIC URETHRITIS
TUBERCULOSIS (RARE)TUBERCULOSIS (RARE)
URETHRITISURETHRITIS
PERIURETHRAL ABSCESSPERIURETHRAL ABSCESS
PERIURETHRAL FIBROSISPERIURETHRAL FIBROSIS
URETHRAL STRICTUREURETHRAL STRICTURE
HEALINGHEALING

19. 1919
GONORRHEAGONORRHEA
 PREVIOUSLY IT WAS MOSTPREVIOUSLY IT WAS MOST
COMMON CAUSE BUT INCIDENCECOMMON CAUSE BUT INCIDENCE
IS COMING DOWN RAPIDLY DUEIS COMING DOWN RAPIDLY DUE
TO AVAILABILITY OF SUITABLETO AVAILABILITY OF SUITABLE
ANTIBIOTIC AGAINSTANTIBIOTIC AGAINST
GONORRHEAGONORRHEA
SITESITE
 POST GONORRHEAL STRICTURESPOST GONORRHEAL STRICTURES
OCCURS ATOCCURS AT
 IN THE BULB 70-80%IN THE BULB 70-80%
 PENOSCROTAL JUNCTIONPENOSCROTAL JUNCTION
 DISTILL PART OF SPONGI URETHRADISTILL PART OF SPONGI URETHRA

20. 2020
 IT PRODUCES MULTIPLEIT PRODUCES MULTIPLE
STRICTURESTRICTURE
 POST GONORRHEAL STRICTURESPOST GONORRHEAL STRICTURES
NEVER SEEN IN MEMBRANOUSNEVER SEEN IN MEMBRANOUS
AND PROSTATIC PART OFAND PROSTATIC PART OF
URETHRAURETHRA
 POST GONORRHEAL STRICTUREPOST GONORRHEAL STRICTURE
APPEARS WITH IN 1 YEAR OFAPPEARS WITH IN 1 YEAR OF
INFECTION BUT THEY MAY NOTINFECTION BUT THEY MAY NOT
CAUSES DIFFICULTY INCAUSES DIFFICULTY IN
MICTURTION FOR 10-15 YEARS.MICTURTION FOR 10-15 YEARS.

21. 2121
TRAUMATICTRAUMATIC (MOST COMMON)(MOST COMMON)
URETHRA CAN BE DAMAGED BYURETHRA CAN BE DAMAGED BY
PASSAGE OF CALCULUS ORPASSAGE OF CALCULUS OR
FBFB
EXTERNAL TRAUMA – TWOEXTERNAL TRAUMA – TWO
COMMON INJURIESCOMMON INJURIES
STRADDLE INJURYSTRADDLE INJURY
DAMAGE TO PELVIC GIRDLEDAMAGE TO PELVIC GIRDLE

22. 2222

23. 2323
PROLONGED LABOURPROLONGED LABOUR
PRESSURE OF FETAL HEAD ONPRESSURE OF FETAL HEAD ON
URETHRA – URETHRAL NECROSISURETHRA – URETHRAL NECROSIS
– HEALING – URETHRAL– HEALING – URETHRAL
STRICTURE.STRICTURE.
SPONTANEOUS RUPTURESPONTANEOUS RUPTURE
IT CAN OCCURS WITH A PREIT CAN OCCURS WITH A PRE
EXISTING URETHRAL STRICTUREEXISTING URETHRAL STRICTURE
WITH BACK PRESSUREWITH BACK PRESSURE

24. 2424
NEW GROWTHNEW GROWTH
NEW GROWTH IN URETHRANEW GROWTH IN URETHRA
(UNCOMMON) – BLOCK TO(UNCOMMON) – BLOCK TO
URINARY FLOWURINARY FLOW
USUALLY IT IS THE EFFECTUSUALLY IT IS THE EFFECT
OF THERAPY ON THEOF THERAPY ON THE
URETHRAL GROWTH WHICHURETHRAL GROWTH WHICH
PRODUCES STRICTUREPRODUCES STRICTURE

25. 2525

26. 2626
 OBSTRUCTIONS TO THE OUTFLOWOBSTRUCTIONS TO THE OUTFLOW
OF URINEOF URINE
 GRADUALLY CAUSES DILATATIONGRADUALLY CAUSES DILATATION
OF URETHRA PROXIMAL TO THEOF URETHRA PROXIMAL TO THE
STRICTURESTRICTURE
 COMPENSATORY HYPERTROPHYCOMPENSATORY HYPERTROPHY
OF BLADDER MUSCULATURE WITHOF BLADDER MUSCULATURE WITH
FORMATION OF DIVERTICULI.FORMATION OF DIVERTICULI.
 BACK PRESSURE MAY RESULT INBACK PRESSURE MAY RESULT IN
HYDRONEPHROSIS ORHYDRONEPHROSIS OR
HYDROURETERHYDROURETER

27. 2727
 DUE TO STASIS OF URINEDUE TO STASIS OF URINE
 INFECTIONINFECTION
PROSTATITISPROSTATITIS
CYSTITISCYSTITIS
PYELONEPHRITISPYELONEPHRITIS
 DUE TO STASIS OF URINEDUE TO STASIS OF URINE
+INFECTION+INFECTION
 CALCULI FORMATIONCALCULI FORMATION
BLADDER CALCULIBLADDER CALCULI
RENAL CALCULUS IN PELVIS OFRENAL CALCULUS IN PELVIS OF
URETERURETER

28. 2828
INFECTION OF STAGNANT URINEINFECTION OF STAGNANT URINE
JUST PROXIMAL TO STRICTUREJUST PROXIMAL TO STRICTURE
PERI URETHRAL ABSCESSPERI URETHRAL ABSCESS
URINARY FISTULAURINARY FISTULA
PATIENTS PASSES MOST OF URINEPATIENTS PASSES MOST OF URINE
THROUGH FISTULATHROUGH FISTULA
WATERING CAN PERINEUMWATERING CAN PERINEUM
RUPTURE
K/a

29. 2929
RETENTION OF URINERETENTION OF URINE
URETHRAL STRICTUREURETHRAL STRICTURE
OBSTRUCTION OF URINE FLOWOBSTRUCTION OF URINE FLOW
RETENTION OF URINERETENTION OF URINE
DUE TO STRAININGDUE TO STRAINING
 PATIENT MAY STRAIN TO OVER COMEPATIENT MAY STRAIN TO OVER COME
OBSTRUCTION TO THE FLOW OF URINE MAYOBSTRUCTION TO THE FLOW OF URINE MAY
LEAD TO: -LEAD TO: -
 HERNIAHERNIA
 HEMORRHOIDSHEMORRHOIDS
 RECTAL PROLEPSESRECTAL PROLEPSES

30. 3030

31. 3131
SYMPTOMSSYMPTOMS
 GRADUAL DIMINUTION OF FORCE ANDGRADUAL DIMINUTION OF FORCE AND
CALIBRE OF URINARY STREAM (MOSTCALIBRE OF URINARY STREAM (MOST
COMMON)COMMON)
 SUDDEN URINARY RETENTIONSUDDEN URINARY RETENTION
 SYMPTOMS OF CYSTITIS: -SYMPTOMS OF CYSTITIS: -
 INCREASED FREQUENCYINCREASED FREQUENCY
 URGENCYURGENCY
 NOCTURIANOCTURIA
 AS COMPARE TO OBSTRUCTION DUEAS COMPARE TO OBSTRUCTION DUE
TO ENLARGE PROSTATE PATIENT ISTO ENLARGE PROSTATE PATIENT IS
CONSIDERABLY YOUNGERCONSIDERABLY YOUNGER

32. 3232
SIGNSSIGNS
 NO SIGN AT ALLNO SIGN AT ALL
 STRICTURE MAY BE PALPABLESTRICTURE MAY BE PALPABLE
IN LONG STANDING CASESIN LONG STANDING CASES
 TENDER MASS – DUE TO PERITENDER MASS – DUE TO PERI
URETHRAL ABSCESSURETHRAL ABSCESS
 URINARY FISTULA – IN LATEURINARY FISTULA – IN LATE
UNTREATED CASESUNTREATED CASES
 EXTERNAL MEATUS – MAY BEEXTERNAL MEATUS – MAY BE
CLOSED WITH AREA OFCLOSED WITH AREA OF
THICKENINGTHICKENING

33. 3333
 BLADDER MAY BE DISTENDED &BLADDER MAY BE DISTENDED &
PALPABLEPALPABLE
 RECTAL EXAMINATION MAYRECTAL EXAMINATION MAY
REVEAL INFECTION IN PROSTATEREVEAL INFECTION IN PROSTATE
 ATTENTION SHOULD BE PAID TOATTENTION SHOULD BE PAID TO
THE PRESENCE OF LOWERTHE PRESENCE OF LOWER
ABDOMINAL WOUND WHICHABDOMINAL WOUND WHICH
SUGGEST THE POSSIBILITY OFSUGGEST THE POSSIBILITY OF
PREVIOUS UROLOGICALPREVIOUS UROLOGICAL
SURGERY.SURGERY.

34. 3434

35. 3535
BASED ON: -BASED ON: -
SUGGESTIVE HISTORYSUGGESTIVE HISTORY
FINDING ON PHYSICALFINDING ON PHYSICAL
EXAMINATIONEXAMINATION
RADIOGRAPHICRADIOGRAPHIC
TECHNIQUETECHNIQUE
ENDOSCOPIC TECHNIQUEENDOSCOPIC TECHNIQUE
URINARY FLOW STUDIESURINARY FLOW STUDIES

36. 3636
OTHER INVESTIGATIONSOTHER INVESTIGATIONS
 BLOOD UREA, S. CREATININE – TOBLOOD UREA, S. CREATININE – TO
RULE OUT UPPER URINARY TRACTRULE OUT UPPER URINARY TRACT
DAMAGE.DAMAGE.
 BACTERIOLOGY – ON MSU SHOULDBACTERIOLOGY – ON MSU SHOULD
BE CHECKED – UTIBE CHECKED – UTI
 SEROLOGY – TO EXCLUDESEROLOGY – TO EXCLUDE
VENEREAL INFECTIONVENEREAL INFECTION
 KUB USG FOR STONE ORKUB USG FOR STONE OR
EVALUATE THE EFFECT OF BACKEVALUATE THE EFFECT OF BACK
PRESSER ON UPPER URINARYPRESSER ON UPPER URINARY
TRACTTRACT

37. 3737
RADIOGRAPHIC EVALUATIONRADIOGRAPHIC EVALUATION
 RADIOGRAPHIC EVALUATION OFRADIOGRAPHIC EVALUATION OF
URETHRA WITH CONTRASTURETHRA WITH CONTRAST
STUDIES BEST ACHIEVED BYSTUDIES BEST ACHIEVED BY
RETROGRADE CYSTORETROGRADE CYSTO
URETHROGRAMURETHROGRAM
ANTEGRADE CYTO-ANTEGRADE CYTO-
URETHROGRAM IF PATIENTSURETHROGRAM IF PATIENTS
HAVE EXISTING SUPRAPUBICHAVE EXISTING SUPRAPUBIC
CATHETERCATHETER

38. 3838
 THESE STUDIES CAN BE USEDTHESE STUDIES CAN BE USED
TO DIAGNOSE AND DEFINE THETO DIAGNOSE AND DEFINE THE
EXTENT OF THE URETHRALEXTENT OF THE URETHRAL
STRICTURESTRICTURE
 ACCURATELY DOCUMENTINGACCURATELY DOCUMENTING
THE EXTENT AND LOCATION OFTHE EXTENT AND LOCATION OF
THE STRICTURE IS IMPORTANTTHE STRICTURE IS IMPORTANT
SO THAT MOST EFFECTIVESO THAT MOST EFFECTIVE
TREATMENT OPTIONS CAN BETREATMENT OPTIONS CAN BE
OFFERED TO THE PATIENTS.OFFERED TO THE PATIENTS.
RADIOGRAPHIC EVALUATIONRADIOGRAPHIC EVALUATION

39. 3939

40. 4040

41. 4141
ENDOSCOPIC EVALUATIONENDOSCOPIC EVALUATION
 CAN BE DONE BY FLEXIBLE ORCAN BE DONE BY FLEXIBLE OR
RIGID CYSTO URETHROSCOPYRIGID CYSTO URETHROSCOPY
 FLEXIBLE CYSTOFLEXIBLE CYSTO
URETHROSCOPY CAN BEURETHROSCOPY CAN BE
PERFORMED WITH LITTLEPERFORMED WITH LITTLE
DISCOMFORT TO THE PATIENTDISCOMFORT TO THE PATIENT
USING ONLY LOCAL ANESTHESIAUSING ONLY LOCAL ANESTHESIA
SUCH AS 2% LIDOCAINE JELLYSUCH AS 2% LIDOCAINE JELLY
INTRAURETHRALLYINTRAURETHRALLY

42. 4242

43. 4343
ENDOSCOPIC EVALUATION (CONT.)ENDOSCOPIC EVALUATION (CONT.)
 IT CONFIRM THE DIAGNOSIS VERYIT CONFIRM THE DIAGNOSIS VERY
PRECISELYPRECISELY
 STRICTURE IS SEEN AS WHITESTRICTURE IS SEEN AS WHITE
FIBROUS TISSUE AROUND A SMALLFIBROUS TISSUE AROUND A SMALL
HOLEHOLE
 URETHRA MAY BE CENTRALLYURETHRA MAY BE CENTRALLY
SITUATED OR TOWARDS THESITUATED OR TOWARDS THE
ROOF OR FLOOR. THE STRICTUREROOF OR FLOOR. THE STRICTURE
MAY TAKE THE FORM OFMAY TAKE THE FORM OF
CRESCENT.CRESCENT.

44. 4444
URINARY FLOW STUDIESURINARY FLOW STUDIES
GIVE AN OBJECTIVEGIVE AN OBJECTIVE
MEASUREMENT OF DEGREEMEASUREMENT OF DEGREE
OF OBSTRUCTION AND ANYOF OBSTRUCTION AND ANY
CHANGES OCCURRINGCHANGES OCCURRING
SUBSEQUENT TO TREATMENTSUBSEQUENT TO TREATMENT

45. 4545

46. 4646
URETHRAL DILATATIONURETHRAL DILATATION
INTERNALINTERNAL
URETHROSTOMYURETHROSTOMY
MEATOTOMYMEATOTOMY
PERMANENT URETHRALPERMANENT URETHRAL
STENTSTENT
LASERLASER
OPEN RECONSTRUCTIONOPEN RECONSTRUCTION

47. 4747
URETHRAL DILATATIONURETHRAL DILATATION
 TRADITIONAL METHODTRADITIONAL METHOD
 MAJORITY OF STRICTURESMAJORITY OF STRICTURES
RESPOND TO THIS.RESPOND TO THIS.
 UNDER ASEPTIC CONDITIONUNDER ASEPTIC CONDITION
URETHRA IS STRETCHED USINGURETHRA IS STRETCHED USING
GRADUATED SERIES OF DILATORSGRADUATED SERIES OF DILATORS
 CURATIVE IN PT. WITH ISOLATEDCURATIVE IN PT. WITH ISOLATED
EPITHELIAL STRICTURE (NOTEPITHELIAL STRICTURE (NOT
INVOLVEMENT OF CORPUSINVOLVEMENT OF CORPUS
SPONGIOSUM)SPONGIOSUM)

48. 4848

49. 4949

50. 5050
INTERMITTENT DILATATIONINTERMITTENT DILATATION
 FIRST – BIWEEKLYFIRST – BIWEEKLY
 WEEKLY – FOR ONE MONTHWEEKLY – FOR ONE MONTH
 FORTNIGHTLY – 3 MONTHFORTNIGHTLY – 3 MONTH
 MONTHLY – 6 MONTHMONTHLY – 6 MONTH
 ½ YEARLY – FOR 2 YEARS THEN½ YEARLY – FOR 2 YEARS THEN
 ONCE A YEAR – PREFERABLY ONONCE A YEAR – PREFERABLY ON
THE BIRTH DAY EASY TOTHE BIRTH DAY EASY TO
REMEMBER.REMEMBER.

51. 5151
COMPLICATION OF DILATATIONCOMPLICATION OF DILATATION
1.1. FALSE PASSAGE / FISTULAFALSE PASSAGE / FISTULA
2.2. INFECTIONINFECTION
3.3. HEMORRHAGEHEMORRHAGE

52. 5252

53. 5353
INDICATIONINDICATION
FAILURE TO DILATE THEFAILURE TO DILATE THE
STRICTURESTRICTURE
RAPID RECURRENCE OFRAPID RECURRENCE OF
STRICTURESTRICTURE

54. 5454
VARIOUS PROCEDURESVARIOUS PROCEDURES
 MEATOTOMYMEATOTOMY
 DIVISION OF STRICTURE AT EXTDIVISION OF STRICTURE AT EXT
MEATUSMEATUS
 SCAR AREA IS EXCISED &SCAR AREA IS EXCISED &
EDGES ARE PLICATEDEDGES ARE PLICATED
 POST OPERATIVE DILATATIONPOST OPERATIVE DILATATION
IS REQUIREDIS REQUIRED

55. 5555

56. 5656
INTERNAL URETHROTOMYINTERNAL URETHROTOMY
 OPTICAL URETHROTOME IS USEDOPTICAL URETHROTOME IS USED
 STRICTURE CUT UNDER VISUALSTRICTURE CUT UNDER VISUAL
CONTROL.CONTROL.
 STRICTURE IS CUT USUALLY AT 12STRICTURE IS CUT USUALLY AT 12
‘0’ CLOCK POSITION.‘0’ CLOCK POSITION.
 CARE SHOULD BE TAKEN NOT TOCARE SHOULD BE TAKEN NOT TO
CUT TOO DEEPLY INTO VASCULARCUT TOO DEEPLY INTO VASCULAR
SPACE AT CORPUS SPONGIOSUMSPACE AT CORPUS SPONGIOSUM
 IF ONE CUT IS INSUFFICIENTIF ONE CUT IS INSUFFICIENT
ANOTHER CUT CAN BE MADE UNTILANOTHER CUT CAN BE MADE UNTIL
THERE IS WIDE PASSAGETHERE IS WIDE PASSAGE

57. 5757
ADVANTAGEADVANTAGE
 MINIMIZE THE CHANCES OFMINIMIZE THE CHANCES OF
FALSE PASSAGE FORMATIONFALSE PASSAGE FORMATION
 STRICTURE IS CUT ONE POSITIONSTRICTURE IS CUT ONE POSITION
– NO GENERALIZED TRAUMA TO– NO GENERALIZED TRAUMA TO
URETHRA.URETHRA.

58. 5858
COMPLICATIONCOMPLICATION
 RECURRENCE OF STRICTURE (MOSTRECURRENCE OF STRICTURE (MOST
COMMON)COMMON)
 BLEEDINGBLEEDING
 EXTRAVASATIONS OF IRRIGATION FLUIDEXTRAVASATIONS OF IRRIGATION FLUID
INTO PERI URETHRA SONGIAL TISSUE –INTO PERI URETHRA SONGIAL TISSUE –
INCREASED FIBROTIC RESPONSEINCREASED FIBROTIC RESPONSE
SUCCESS RATESUCCESS RATE
 REPORTED AS 20-35%REPORTED AS 20-35%
 NO INCREASE IN SUCCESS RATE WITHNO INCREASE IN SUCCESS RATE WITH
SECOND INTERNAL URETHROTOMYSECOND INTERNAL URETHROTOMY
PROCESSPROCESS

59. 5959
URETHRAL STENTURETHRAL STENT
 PLACED ENDOSCOPICALLYPLACED ENDOSCOPICALLY
 UROLUME MADE ALLOY ISUROLUME MADE ALLOY IS
INCORPORATED TO WALL OF URETHRAINCORPORATED TO WALL OF URETHRA
& CORPUS SPONGIOSUM PROVIDING& CORPUS SPONGIOSUM PROVIDING
PATENT LUMAN.PATENT LUMAN.
 ACTS BY OPPOSING THE FORCE OFACTS BY OPPOSING THE FORCE OF
WALL CONTRACTION AFTER INTERNALWALL CONTRACTION AFTER INTERNAL
URETUROTOMY & DILATATIONURETUROTOMY & DILATATION
 BEST EMPLOYED FOR SHORTBEST EMPLOYED FOR SHORT
STRICTURE OF BULBAR URETHRA WITHSTRICTURE OF BULBAR URETHRA WITH
MINIMAL SPONGIOFIBROSIS.MINIMAL SPONGIOFIBROSIS.

60. 6060

61. 6161

62. 6262
COMPLICATIONCOMPLICATION
 PAIN – STENT PLACED DISTILL TOPAIN – STENT PLACED DISTILL TO
BULBOUS URETHRA – PAIN WHILEBULBOUS URETHRA – PAIN WHILE
SITTING OR INTERCOURSESITTING OR INTERCOURSE
 MIGRATION OF STENTMIGRATION OF STENT
CONTRAINDICATIONCONTRAINDICATION
 STRICTURE ASSOCIATED WITH DEEPSTRICTURE ASSOCIATED WITH DEEP
SPONGIO FIBROSISSPONGIO FIBROSIS
 WITH PRIOR URETHRALWITH PRIOR URETHRAL
RECONSTRUCTION WHERE SKINRECONSTRUCTION WHERE SKIN
INCORPORATED INTO URETHRAINCORPORATED INTO URETHRA
BECAUSE CONTACT OF SKIN WITHBECAUSE CONTACT OF SKIN WITH
UROLUME STENT ASSOCIATED WITHUROLUME STENT ASSOCIATED WITH
VIRULENT HYPER TROPIC REACTION.VIRULENT HYPER TROPIC REACTION.

63. 6363
INDICATION (URETHRAL STENT)INDICATION (URETHRAL STENT)
BEST RESERVED FOR PATIENTSBEST RESERVED FOR PATIENTS
OLDER THAN 50 YEARS ANDOLDER THAN 50 YEARS AND
MEDICALLY UNFIT FOR LENGTHYMEDICALLY UNFIT FOR LENGTHY
OPEN URETHRALOPEN URETHRAL
RECONSTRUCTIONRECONSTRUCTION

64. 6464

65. 6565
IDEAL LASER FOR TRETMENT OFIDEAL LASER FOR TRETMENT OF
URETHRAL STRICTURE DIS.URETHRAL STRICTURE DIS.
WOULD BE ONE THAT:-WOULD BE ONE THAT:-
 TOTALLY VAPORIZING OF TISSUETOTALLY VAPORIZING OF TISSUE
 EXHIBITS NEGLIGIBLEEXHIBITS NEGLIGIBLE
PERIPHERAL TISSUEPERIPHERAL TISSUE
DESTRUCTIONDESTRUCTION
 NOT ABSORBED BY WATERNOT ABSORBED BY WATER
 EASILY PROPAGATED ALONG THEEASILY PROPAGATED ALONG THE
FIBRES.FIBRES.

66. 6666
VARIOUS LASER USEVARIOUS LASER USE
COCO22 LASERLASER
ARGON LASERARGON LASER
Nd: YAG LASERNd: YAG LASER
HOLMIUM : YAG LASERHOLMIUM : YAG LASER
EXCIMER LASEREXCIMER LASER

67. 6767
OPEN RECONSTRUCTIONOPEN RECONSTRUCTION
 URETHRAL STRICTURE ITSELF ISURETHRAL STRICTURE ITSELF IS
IMPALPABLEIMPALPABLE
 ANY THICKNESS FELT CLINICALLY OR ATANY THICKNESS FELT CLINICALLY OR AT
SURGERY IS DUE TO SURROUNDINGSURGERY IS DUE TO SURROUNDING
SPONGIO FIBROSISSPONGIO FIBROSIS
 NORMAL URETHRAL LINING SURFACE ISNORMAL URETHRAL LINING SURFACE IS
PINK DUE TO UNDERLYING VASCULARPINK DUE TO UNDERLYING VASCULAR
SPONGY TISSUE IS SEEN THROUGH THESPONGY TISSUE IS SEEN THROUGH THE
TRANSLUCENT UROEPITHELIUM.TRANSLUCENT UROEPITHELIUM.
 PROXIMAL & DISTAL TO STRICTUREPROXIMAL & DISTAL TO STRICTURE
UNSTRICTURED URETHRA SURROUNDEDUNSTRICTURED URETHRA SURROUNDED
BY SPONGIO FIBROSIS GIVES GRAY/BY SPONGIO FIBROSIS GIVES GRAY/
YELLOW COLOUR (GRAY URETHRA)YELLOW COLOUR (GRAY URETHRA)

68. 6868
 THIS UNSTRICTURED SPONGIO-THIS UNSTRICTURED SPONGIO-
FIBROTIC URETHRA HAVEFIBROTIC URETHRA HAVE
INCREASED TENDENCY TOINCREASED TENDENCY TO
STENOSIS IN RESPONSE TOSTENOSIS IN RESPONSE TO
MINIMAL TRAUMA.MINIMAL TRAUMA.
 DURING EXCISION WHOLEDURING EXCISION WHOLE
LENGTH OF ABNORMALLENGTH OF ABNORMAL
URETHRA (STRICTURED + GRAYURETHRA (STRICTURED + GRAY
URETHRA) MUST BE EXCISED.URETHRA) MUST BE EXCISED.

69. 6969

70. 7070
PRIMARY REPAIRPRIMARY REPAIR
 EXCISION OF FIBROTIC URETHRAL SEGMENTEXCISION OF FIBROTIC URETHRAL SEGMENT
WITH REANASTOMOSIS (End To End)WITH REANASTOMOSIS (End To End)
 KEY TECHNICAL POINTKEY TECHNICAL POINT
 COMPLETE EXCISION OF THE AREA OFCOMPLETE EXCISION OF THE AREA OF
FIBROSISFIBROSIS
 TENSION FREE ANASTOMOSISTENSION FREE ANASTOMOSIS
 WIDELY PATENT ANASTOMOSISWIDELY PATENT ANASTOMOSIS
 USED FOR STRICTURE LENGTH 1.2 CM.USED FOR STRICTURE LENGTH 1.2 CM.
 WITH EXTENSIVE MOBILIZATION OF CORPUSWITH EXTENSIVE MOBILIZATION OF CORPUS
SPONGIOSUM STRICTURE 3-4 CM CAN BESPONGIOSUM STRICTURE 3-4 CM CAN BE
REPAIREDREPAIRED
 REPAIR IS STUNTED WITH SMALL SILICONREPAIR IS STUNTED WITH SMALL SILICON
CATHETER.CATHETER.
 BLADDER IS DRAINED WITH A SUPRAPUBICBLADDER IS DRAINED WITH A SUPRAPUBIC
CATHETER.CATHETER.

71. 7171

72. 7272
TWO STAGE PROCEDURETWO STAGE PROCEDURE
 IF STRICTURE IS TOO LONG FOR PRIMARYIF STRICTURE IS TOO LONG FOR PRIMARY
ANASTOMOSIS TWO STAGE PROCEDURE ISANASTOMOSIS TWO STAGE PROCEDURE IS
INDICATEDINDICATED
FIRST STAGEFIRST STAGE
 STRICTURE AND ASSOCIATED FIBROUSSTRICTURE AND ASSOCIATED FIBROUS
TISSUE ARE EXCISEDTISSUE ARE EXCISED
 SKIN IS APPROXIMATED AND SUTURE TOSKIN IS APPROXIMATED AND SUTURE TO
MARGINS OF THE RAW STRICTURE BED.MARGINS OF THE RAW STRICTURE BED.
 RAW STRICTURE BED AREA ALLOW FORRAW STRICTURE BED AREA ALLOW FOR
EPITHELIZATIONEPITHELIZATION
 THIS NEW EPITHELIUM WILL BE LUMINALTHIS NEW EPITHELIUM WILL BE LUMINAL
SURFACE OF NEW CONSTRUCTED URETHRA.SURFACE OF NEW CONSTRUCTED URETHRA.

73. 7373

74. 7474
IIIINDND
STAGE AFTERSTAGE AFTER
THREE MONTHSTHREE MONTHS

75. 7575
OVAL INCISION ENCOMPASSING THEOVAL INCISION ENCOMPASSING THE
CUT URETHRAL ENDS.CUT URETHRAL ENDS.

76. 7676
LATERAL MARGINS ARE UNDERMINED ANDLATERAL MARGINS ARE UNDERMINED AND
FLAP SUTURED OVER URETHRAL CATHETER.FLAP SUTURED OVER URETHRAL CATHETER.

77. 7777
 SKIN FLAPS ARE APPROXIMATED ANDSKIN FLAPS ARE APPROXIMATED AND
SUTURED TOGETHER IN MID LINESUTURED TOGETHER IN MID LINE
 CATHETER IS RETAINED FOR 7-10CATHETER IS RETAINED FOR 7-10
DAYS.DAYS.

78. 7878
REPAIR UTILIZING TISSUEREPAIR UTILIZING TISSUE
TRANSFER TECHNIQUETRANSFER TECHNIQUE
 FREE GRAFTS: - SUCCESS DEPENDS UPONFREE GRAFTS: - SUCCESS DEPENDS UPON
THE BLOOD SUPPLY OF LOCAL TISSUE ATTHE BLOOD SUPPLY OF LOCAL TISSUE AT
THE SITE OF PLACEMENTTHE SITE OF PLACEMENT
 VARIOUS GRAFT ARE: -VARIOUS GRAFT ARE: -
 FULL THICKNESS SKIN GRAFTFULL THICKNESS SKIN GRAFT
 NON HAIR BEARING AREA SHOULD BENON HAIR BEARING AREA SHOULD BE
UTILIZEDUTILIZED
 MOST SUCCESSFUL IN BULBOUSMOST SUCCESSFUL IN BULBOUS
URETHRAURETHRA

79. 7979
REPAIR UTILIZING TISSUEREPAIR UTILIZING TISSUE
TRANSFER TECHNIQUETRANSFER TECHNIQUE
 SPLIT THICKNESS GRAFTSPLIT THICKNESS GRAFT
 NOT PREFERRED FOR SINGLE STAGENOT PREFERRED FOR SINGLE STAGE
REPAIR DUE TO CONTRACTIONREPAIR DUE TO CONTRACTION
CHARACTERISTICS OF THE GRAFT.CHARACTERISTICS OF THE GRAFT.
 THIS IS RESERVED FOR THETHIS IS RESERVED FOR THE
PATIENTS IN WHOM MULTIPLEPATIENTS IN WHOM MULTIPLE
PROCEDURE HAVE FAILED ANDPROCEDURE HAVE FAILED AND
LOCAL SKIN IS INSUFFICIENT FORLOCAL SKIN IS INSUFFICIENT FOR
FURTHER RECONSTRUCTIONFURTHER RECONSTRUCTION
 IT IS CONDUCTED AS TWO STAGEIT IS CONDUCTED AS TWO STAGE
PROCEDUREPROCEDURE

80. 8080
 BUCCAL MUCOSAL GRAFTBUCCAL MUCOSAL GRAFT
15-20 MM GRAFT IS15-20 MM GRAFT IS
HARVESTED FROM ORALHARVESTED FROM ORAL
MUCOSA SUTURED TO EDGEMUCOSA SUTURED TO EDGE
OF URETHRAOF URETHRA
 BLADDER MUCOSAL GRAFTBLADDER MUCOSAL GRAFT
NOT POPULAR DUE TONOT POPULAR DUE TO
DIFFICULTY IN HARVESTINGDIFFICULTY IN HARVESTING
AND HANDLING OF THEAND HANDLING OF THE
TISSUETISSUE

81. 8181
PEDICLE SKIN FLAPSPEDICLE SKIN FLAPS
 MOBILIZATION AN ISLAND OF EPITHELIALMOBILIZATION AN ISLAND OF EPITHELIAL
BEARING TISSUE WITH A PEDICLE OFBEARING TISSUE WITH A PEDICLE OF
FASCIA TO PROVIDE IT’S OWN BLOODFASCIA TO PROVIDE IT’S OWN BLOOD
SUPPLY.SUPPLY.
 PENILE SKIN REPRESENT AN IDEAL TISSUEPENILE SKIN REPRESENT AN IDEAL TISSUE
SUBSTITUTE BECAUSE IT IS THIN. MOBILESUBSTITUTE BECAUSE IT IS THIN. MOBILE
AND HAS AN EXCELLENT BLOOD SUPPLYAND HAS AN EXCELLENT BLOOD SUPPLY
 VARIOUS PEDICLE FLAPSVARIOUS PEDICLE FLAPS
 SKIN ISLAND ONLY FLAPSKIN ISLAND ONLY FLAP
 HAIRLESS SCROTAL ISLAND FLAPHAIRLESS SCROTAL ISLAND FLAP
 SKIN ISLAND TUBULARIZED FLAP.SKIN ISLAND TUBULARIZED FLAP.

82. 8282
SCROTAL FLAPSCROTAL FLAP
URETHROPLASTYURETHROPLASTY

83. 8383

84. 8484

85. 8585

86. 8686
DEVELOPMENTDEVELOPMENT

87. 8787

88. 8888
PRE OPERATIVE DETAILSPRE OPERATIVE DETAILS
 MEDICALLY STABLE FOR SELECTEDMEDICALLY STABLE FOR SELECTED
PROCEDUREPROCEDURE
 URINE CULTURE SHOULD BEURINE CULTURE SHOULD BE
STERILESTERILE
 DISEASE SHOULD THOROUGHLYDISEASE SHOULD THOROUGHLY
EVALUATED WITH RADIOGRAPHICEVALUATED WITH RADIOGRAPHIC
AND ENDOSCOPIC TECHNIQUESAND ENDOSCOPIC TECHNIQUES
 PROCEDURE SELECTION SHOULDPROCEDURE SELECTION SHOULD
BE DISCUSSED THOROUGHLY WITHBE DISCUSSED THOROUGHLY WITH
THE PATIENTS IN ADVANCETHE PATIENTS IN ADVANCE

89. 8989
 DISCUSSION SHOULD INCLUDE: -DISCUSSION SHOULD INCLUDE: -
 RISK AND BENEFITS OF THERISK AND BENEFITS OF THE
PROCEDURE AND POSTPROCEDURE AND POST
OPERATIVE CAREOPERATIVE CARE
 RISK INCLUDE BUT ARE NOTRISK INCLUDE BUT ARE NOT
LIMITED TO BLEEDING INFECTIONLIMITED TO BLEEDING INFECTION
RECURRENCE OF STRICTURERECURRENCE OF STRICTURE
AND URETHRO CUTANEOUSAND URETHRO CUTANEOUS
FISTULA FORMATIONFISTULA FORMATION

90. 9090
FOLLOW-UP CAREFOLLOW-UP CARE
INTERNAL URETHROTOMYINTERNAL URETHROTOMY
REMOVAL OF CATHETER ONREMOVAL OF CATHETER ON
3-5 POD.3-5 POD.
OPEN REPAIROPEN REPAIR
DRAIN SHOULD BEDRAIN SHOULD BE
REMOVED ON 3 PODREMOVED ON 3 POD

91. 9191
REMOVAL OF SUPRAPUBIC
CATHETER
VOIDING CYSTOURETHROGRAM
NO EVIDENCE OF CONTRAST EXTRAVASATION
SUTURE LINE INTACT
CATHETER IS REMOVED &
SUPERAPUBIC TUBE IS CAPPED
IF THE PT. VOID WELL
SPC REMOVED
AFTER 1 WK.

92. 9292
 WHEN ALL TUBES AREWHEN ALL TUBES ARE
REMOVED + NO EVIDENCE OFREMOVED + NO EVIDENCE OF
INFECTION -INFECTION - ANTIBIOTIC MAY BEANTIBIOTIC MAY BE
DISCONTINUEDDISCONTINUED
 URETHRAL EVALUATIONURETHRAL EVALUATION
SHOULD BE CONDUCTED WITHSHOULD BE CONDUCTED WITH
RETROGRADE URETHROGRAMRETROGRADE URETHROGRAM
OR FLEXIBLE URETHROSCOPYOR FLEXIBLE URETHROSCOPY
AT 4 MONTH AND 1 YEAR.AT 4 MONTH AND 1 YEAR.

93. 9393
OUTCOME AND PROGNOSISOUTCOME AND PROGNOSIS
 URETHRAL DILATION ANDURETHRAL DILATION AND
INTERNAL URETHROTOMYINTERNAL URETHROTOMY
 STEEN KAMP AND COLLEAGUESSTEEN KAMP AND COLLEAGUES
(1997) CONDUCTED A(1997) CONDUCTED A
PROSPECTIVE STUDY ANDPROSPECTIVE STUDY AND
FOUND NO SIGNIFICANTFOUND NO SIGNIFICANT
DIFFERENCE IN EFFICACYDIFFERENCE IN EFFICACY
BETWEEN 2 PROCEDURE WHENBETWEEN 2 PROCEDURE WHEN
USED AS INITIAL TREATMENT .USED AS INITIAL TREATMENT .

94. 9494
 RECURRENCE RATE INCREASED ASRECURRENCE RATE INCREASED AS
LENGTH OF STRICTURE INCREASED.LENGTH OF STRICTURE INCREASED.
 RECURRENCE RATE AT: -RECURRENCE RATE AT: -
12 MONTH12 MONTH : STRICTURE <2CM: STRICTURE <2CM - 40%- 40%
: STRICTURE 2-4CM: STRICTURE 2-4CM - 50%- 50%
: STRICTURE >4CM: STRICTURE >4CM - 80%- 80%

95. 9595
PERMANENT STENTPERMANENT STENT
 MILROY AND ALLEN (1996) REPORTMILROY AND ALLEN (1996) REPORT
84% LONG SUCCESS RATE WITH84% LONG SUCCESS RATE WITH
HIGH LEVEL OF PATIENTSHIGH LEVEL OF PATIENTS
SATISFACTION WITH AS LONG AS 5SATISFACTION WITH AS LONG AS 5
YEAR FOLLOW-UPYEAR FOLLOW-UP
 MARGIA AND COLLEAGUES (1999)MARGIA AND COLLEAGUES (1999)
REPORTED SHORT TERMREPORTED SHORT TERM
COMPLICATIONS (7-28 DAYS).COMPLICATIONS (7-28 DAYS).
 PERINEAL DISCOMFORT (86%)PERINEAL DISCOMFORT (86%)
 DRIBBLING (14%)DRIBBLING (14%)

96. 9696
LONG TERMLONG TERM
 PAINFUL ERECTIONPAINFUL ERECTION -- 44%44%
 MUCOUS HYPERPLASIAMUCOUS HYPERPLASIA -- 44%44%
 RECURRING STRICTURERECURRING STRICTURE -- 29%29%
 INCONTINENCEINCONTINENCE -- 14%14%
FREE GRAFT REPAIRFREE GRAFT REPAIR
 OVER ALL SUCCESS RATE IS 84.5%OVER ALL SUCCESS RATE IS 84.5%
PEDICAL SKIN GRAFTPEDICAL SKIN GRAFT
 OVER ALL SUCCESS RATEOVER ALL SUCCESS RATE -- 85.5%85.5%

97. 9797
FUTURE AND CONTROVERSIESFUTURE AND CONTROVERSIES
RECENTLY, BUCCAL MUCOSARECENTLY, BUCCAL MUCOSA
FREE GRAFT URETHROPLASTYFREE GRAFT URETHROPLASTY
HAS RECEIVED FAVORABLEHAS RECEIVED FAVORABLE
ATTENTION SEC TO ITSATTENTION SEC TO ITS
EXCELLENT EARLY RESULTSEXCELLENT EARLY RESULTS
AND DECREASED LEVEL OFAND DECREASED LEVEL OF
DIFFICULTY COMPARED TODIFFICULTY COMPARED TO
PEDICAL SKIN FLAPPEDICAL SKIN FLAP

98. 9898