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  • Review Article
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Management of distal anterior urethral strictures

Abstract

Management of men with anterior urethral stricture disease is a relatively common issue faced by practicing urologists today. Anterior urethral strictures, which can be the result of congenital, idiopathic, iatrogenic or inflammatory causes, can affect patients of all ages and might present as some or all of the following disorders: difficulty with voiding, urinary tract infection, acute urinary retention and high bladder emptying pressures. A thorough understanding of the urethral anatomy and etiology of the stricture followed by effective treatment are crucial if successful outcomes for the patient are to be achieved. Historically, urologists viewed open repair as an option that should only be offered to patients who had failed to respond to repeated endoscopic treatments—the so-called reconstructive ladder. This dogma has, however, been scrutinized; urologists should be aware that this process may subject patients to repeated procedures with a low success rate, such as dilatation and internal urethrotomy, rather than one potentially curative operation, such as graft or flap urethroplasty.

Key Points

  • A thorough understanding of urethral anatomy as well as the etiology and characteristics of each individual stricture is paramount

  • Assessment of each stricture should include physical examination, radiographic and endoscopic techniques

  • Treatment approaches to each stricture include palliative and curative techniques, the goals of which should be clearly understood by both surgeon and patient

  • Palliative techniques include urethral dilation and internal urethrotomy, whether performed via a cold knife or a laser approach

  • Curative techniques include graft and flap urethroplasty with the goal of achieving adequate caliber and cosmesis of the neo-urethra

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Figure 1: Sagittal section of the pelvis.
Figure 2: Schematic representations of the different techniques of flap meatotomy.
Figure 3: Staged reconstruction of an anterior urethral stricture.
Figure 4: Technique of reconstruction of the fossa navicularis.

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Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Correspondence to Gerald H. Jordan.

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Tonkin, J., Jordan, G. Management of distal anterior urethral strictures. Nat Rev Urol 6, 533–538 (2009). https://doi.org/10.1038/nrurol.2009.181

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