This document discusses urethral strictures, which are pathological narrowing or obliteration of the urethra caused by scar tissue formation. It defines urethral strictures and describes their causes, presentation with obstructive voiding symptoms, and various treatment methods including dilation, urethroplasty surgery using grafts or flaps, and staged repair if the penis is abnormal. It emphasizes careful preoperative, intraoperative, and postoperative care to minimize complications of recurrence, bleeding, infection, and wound issues.

1. URETHRAL STRICTURES
11TH
JUNE,2014
DR. P. MUSAU
MBChB, MMed (Surg), MSc (Urol)

2. URETHRAL STRICTURES..
OUTLINE OF TOPIC
• DEFINITION:
• AETIOLOGY:.
• PATHOPHYSIOLOGY:
• PRESENTATION:
• MODES OF TREATMENT.

3. URETHRAL STRICTURES
• DEFINITION:Pathological, Technical
• AETIOLOGY: Congenital, Acquired
-Ischaemia, infection, inflammation, trauma
• PATHOPHYSIOLOGY: Scar contraction and
luminal narrowing or obliteration
• PRESENTATION:Obstructive voiding
symptoms, urinary retention and complications
e.g. UTI, bladder stones, diverticuli,
urethrocutaneous fistulas and renal failure
• PRESENTATION:• PRESENTATION:

4. URETHRAL STRICTURES Ctd….
• DIAGNOSIS
-History
-Examination
-Investigation
-Diagnostic procedures.

5. URETHRAL STRICTURES Ctd..
• INFORMATION
SOUGHT IN
RADIOLOGIC
INVESTIGATION
-Site(S)
-Number
-Length
-Severity
-Associated anomalies
• X-RAY FILM

6. URETHRAL STRICTURES Ctd…
• TREATMENT OF URETHRAL STRICTURES
-Dichotomy; intention to cure or palliate.
• Dependent on:
-Age of patient
-Aetiology
-Site
-Number
-Length
-Severity
-Condition of patient
-Previous interventions

7. URETHRAL STRICTURES Ctd….
• TREATMENT LADDER:
1. CONSERVATIVE MANAGEMENT:
Permanent stents, Permanent stoma/ SPC
2. POS, DVU, BALLOON DILATATION
3.ANASTOMOTIC URETHROPLASTY
4.SUBSTITUTIONAL URETHROPLASTY
5.STAGED URETHROPLASTY

8. URETHRAL STRICTURES Ctd…
• SURGERY FOR
URETHRAL
STRICTURES:
BROADLY: Primary
repair or staged repair
EITHER WAY: Does the
repair require
substitution. If YES: Is
it a graft or a flap?
IF A GRAFT, WHERE
FROM?
IF A FLAP, IS IT AN
ONLAY OR A
TUBULARISED
FLAP?

9. THE PENIS IS NORMAL
• ONE-STAGE
FLAP or GRAFT
URETHROPLASTY

10. THE PENIS IS NOT NORMAL
TWO-STAGE
GRAFT
URETHROPLASTY

11. URETHRAL STRICTURE Ctd…
• PREOP CARE:
-Ensure fit for surgery
-Ascertain mature tissues
-Eradicate infections
• INTRAOP:
-Proper handling of tissues
-Avoid haematomas
-Suture lines should not overlap
-Ensure no tension
-Adequate patency
-Stent the operation site
• POST OP:
• Tubes
• -Antibiotics
• -Re-evaluation after 4
and 12 months

12. URETHRAL STRICTURES Ctd..
• Complications:
-Bleeding/ haematomas
-UTI
-Wound infection
-Wound dehiscence
-UCF
- Recurrence: Depends on length of stricture, type
of surgery and duration since intervention. In a
year 1-2cm 40%, 2-4cm 50% and 80% for >4cm.
In 4 years, the rate increases to 75% for the 2-4
cm long.