Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis.

PURPOSE: The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy. MATERIALS AND METHODS: A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction. RESULTS: Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment. CONCLUSIONS: D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.

Urethral Stricture Disease Guideline Amendment (2023).

PURPOSE: The symptoms of urethral stricture are non-specific and may overlap with other common conditions that can confound diagnosis. Urologists play a key role in the initial evaluation of urethral stricture, currently provide all accepted treatments, and must be familiar with the evaluation, diagnostic tests, and surgical treatments for urethral stricture. MATERIALS AND METHODS: A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates January 1, 1990 to January 12, 2015) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of urethral stricture in men. The review yielded an evidence base of 250 articles after application of inclusion/exclusion criteria. The search for the 2023 Amendment was modified to included females and males (search dates December 2015-October 2022 for males; January 1990-October 2022 for females) and a new Key Question on sexual dysfunction was added (search dates: January 1990-10/2022). After inclusion and exclusion criteria were applied, 81 studies were added to the existing evidence base. RESULTS: Once a urethral stricture is diagnosed, clinicians should determine the length and location of the stricture in order to inform treatment. After a period of urethral rest, patients with short (<2cm) bulbar urethral stricture may be treated endoscopically. Urethroplasty may be performed by an experienced surgeon in patients with first time or recurrent anterior and posterior urethral strictures. The best treatment option for urethral stricture in female patients is urethroplasty using oral mucosa grafts or vaginal flaps rather than endoscopic treatment. CONCLUSION: This guideline provides evidence-based guidance to clinicians and patients regarding how to recognize symptoms and signs of a urethral stricture/stenosis, carry out appropriate testing to determine the location and severity of the stricture, and recommend the best options for treatment. The most effective approach for a particular patient is best determined by the individual clinician and patient in the context of that patient's history, values, and goals for treatment.

[Double to avoid trouble? An experience of double Memokath(tm) 044TW stents insertion for multiple anterior urethral stricture in hospital universiti sains Malaysia].

For the past two decades urethral stenting became more popular for treatment of urethral stricture. However, urethral stents still not widely used in view of good outcome from urethroplasty surgery. The MemokathTM stent is the most popular in this field. It is manufactured from a biocompatible alloy of nickel and titanium. Most of the studies have been limited to single stent insertion, and no studies done for double stents insertion. An 81-year-old man with history of multiple anterior urethral strictures since 2013. He underwent internal urethrotomy in the same year but failed and was on urinary catheter since then. The MemokathTM 044TW was the option due to patient has multiple comorbidities. The micturating cystourethrogram (MCUG) and ascending urethrogram showed multiple anterior urethral strictures. He underwent direct visual internal urethrotomy and two MemokathTM stents inserted in the whole length of urethral. However, one year after procedure, he had recurrent lower urinary tract symptoms and ultimately developed acute urinary retention (AUR). Patients stents were removed endoscopically. During endoscopic removal, he had encrustation of both stents that causing obstructive symptoms. He is under our follow-up with no recurrent urinary retention or urosepsis with satisfactory uroflowmetry. Stent encrustation is known to be a common late complication of urethral stents. Stent encrustation should be suspected if patient comes with obstructive symptoms. Endoscopic is shown to be the best method to detect the cause of obstructed stent.

Evaluating Tools for Characterizing Anterior Urethral Stricture Disease: A Comparison of the LSE System and the Urethral Stricture Score.

PURPOSE: We evaluated if scores generated by the LSE classification system and the Urethral Stricture Score system are associated with intraoperative surgical complexity and stricture recurrence risk. MATERIALS AND METHODS: We retrospectively reviewed all consenting patients who underwent single-stage anterior urethroplasty by a single surgeon at 2 institutions. Urethral Stricture Score and a numerical LSE "score" was calculated for each patient. Pearson's correlation and linear regression analyses were used to assess for a relationship between increasing Urethral Stricture Score and LSE score and surgical complexity. Kaplan-Meier curves and Cox proportional hazard regression models were used to assess for an association between Urethral Stricture Score and LSE score and stricture recurrence risk. RESULTS: A total of 187 patients with a mean age of 48 years (SD 16) and mean stricture length of 4.2 cm (SD 3.3) were included. Mean follow-up was 21 months. Forty-six patients recurred over time. We found a strong positive linear correlation between Urethral Stricture Score and LSE score (P < .001). Both increasing Urethral Stricture Score and LSE score independently linearly correlated with increasing surgical complexity (both P < .0001). Univariable analysis demonstrated that increasing LSE score was significantly associated with an increased risk of stricture recurrence (HR 1.2, P = .02) but Urethral Stricture Score was not. Patients with a high LSE score (≥7) were nearly 3 times as likely to recur versus patients with a low LSE score (HR 2.7, P = .001). CONCLUSIONS: Increasing Urethral Stricture Score and LSE score are both associated with increasing surgical complexity, but only LSE score is associated with stricture recurrence risk. Conversion of the LSE classification system into a numeric score adds functionality to this novel system.

Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol.

PURPOSE: A successful urethroplasty has been defined in different ways across studies. This variety in the literature makes it difficult to compare success rates and techniques across studies. We aim to evaluate the success of anterior urethroplasty based on different definitions of success in a single cohort. MATERIALS AND METHODS: Data were collected from a multi-institutional, prospectively maintained database. We included men undergoing first-time, single-stage, anterior urethroplasty between 2006 and 2020. Exclusion criteria included lack of followup, hypospadias, extended meatotomy, perineal urethrostomy, posterior urethroplasty and staged repairs. We compared 5 different ways to define a "failed" urethroplasty: 1) stricture retreatment, 2) anatomical recurrence on cystoscopy, 3) peak flow rate <15 ml/second, 4) weak stream on questionnaire and 5) failure by any of these measures. Kaplan-Meier survival curves were generated for each of the definitions. We also compared outcomes by stricture length, location and etiology. RESULTS: A total of 712 men met inclusion criteria, including completion of all types of followup. The 1- and 5-year estimated probabilities of success were "retreatment," 94% and 75%; "cystoscopy," 88% and 71%; "uroflow," 84% and 58%; "questionnaire," 67% and 37%; and "any failure," 57% and 23%. This pattern was inconsistent across stricture length, location and etiology. CONCLUSIONS: The estimated probability of success after first-time, anterior urethroplasty is highly dependent on the way success is defined. The variability in definitions in the literature has limited our ability to compare urethroplasty outcomes across studies.

Urethroscopic Findings following Urethroplasty Predict the Need for Secondary Intervention in the Long Term: A Multi-Institutional Study from Trauma and Urologic Reconstructive Network of Surgeons.

PURPOSE: Postoperative surveillance urethroscopy has been shown to be an effective tool to predict reoperation within 1 year after urethroplasty. We aimed to evaluate early surveillance urethroscopy findings and long-term outcomes among urethroplasty patients in order to define the value of surveillance urethroscopy to predict failure. MATERIALS AND METHODS: We evaluated 304 patients with at least 4 years of followup after urethroplasty performed at 10 institutions across the United States and Canada. All patients were surveilled using a flexible 17Fr cystoscope and were categorized into 3 groups: 1) normal lumen, 2) large-caliber stricture (≥17Fr) defined as the ability of the cystoscope to easily pass the narrowing and 3) small-caliber stricture (<17Fr) that the cystoscope could not be passed. Failure was stricture recurrence requiring a secondary intervention. RESULTS: The median followup time was 64.4 months (range 55.3-80.6) and the time to initial surveillance urethroscopy was 3.7 months (range 3.1-4.8) following urethroplasty. Secondary interventions were performed in 29 of 194 (15%) with normal lumens, 11 of 60 (18.3%) with ≥17Fr strictures and 32 of 50 (64%) with <17Fr strictures (p <0.001). The 1-, 3- and 9-year cumulative probability of intervention was 0.01, 0.06 and 0.23 for normal, 0.05, 0.17 and 0.18 for ≥17Fr, and 0.32, 0.50 and 0.73 for <17Fr lumen groups, respectively. Patient-reported outcome measures performed poorly to differentiate the 3 groups. CONCLUSIONS: Early cystoscopic visualization of scar recurrence that narrows the lumen to <17Fr following urethroplasty is a significant long-term predictor for patients who will eventually undergo a secondary intervention.

Posterior urethral stenosis: a comparative review of the guidelines.

PURPOSE: We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis by the American Urologic Association (2016), Société Internationale d'Urologie (2010), and European Urologic Association (2022). METHODS: The AUA, SIU, and EAU guidelines were evaluated for recommendations on the diagnosis, evaluation, and treatment of posterior urethral stenosis. We also included the EAU and AUA urologic trauma guidelines for the trauma-related stenosis. The level or strength of recommendations is included in case of disparity between the guidelines. RESULTS: The three guidelines align considerably in recommendations provided for the diagnosis, management, and follow-up of patients with posterior urethral stenosis. SIU and EAU emphasize the role of repeat endoscopic treatment in guidelines compared to AUA. CONCLUSION: The preferred method to repair bulbo-membranous stricture/stenosis following radiation therapy remains an area of active interest, focusing on continence preservation. Additionally, there may be a role for advanced endoscopic treatments with or without adjunct therapies to manage even obliterated stenoses.

Comparative review of the guidelines for anterior urethral stricture.

PURPOSE: We aimed to provide a detailed comparison between the American Urologic Association (AUA), Société Internationale d'Urologie (SIU), and the European Association of Urology (EAU) guidelines on the evaluation, management, and follow-up of the patients with anterior urethral stricture disease (USD). METHODS: The urethral stricture guidelines from SUI, AUA, and EAU were collected and evaluated regarding the recommendations on diagnosis, evaluation, and treatment of anterior USD. The strength of evidence for each statement was included and discussed when guidelines differed. RESULTS: While the guidelines remarkably align in terms of the diagnostic workup and follow-up, there is discordance in the management of anterior urethral strictures, specifically for the use of endoscopic treatment and stenting. Further, the EAU offers more comprehensive recommendations regarding urethroplasty techniques and patient follow-up. The EAU guidelines are the most recent and first to offer guidance for USD in transgender people and women. CONCLUSION: Reconstructive urology is a rapidly adapting field, and best practices change accordingly. Guideline statements have become more inclusive and expansive but will require further research to improve the level of evidence and continue to provide patients and providers with the best treatment plans.

Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction: A systematic review.

AIM: To summarize available data focused on diagnosis and management of urethral stricture in men with neurogenic lower urinary tract dysfunction by a systematic review of the literature. MATERIALS AND METHODS: A systematic review of the literature was carried out through an extensive electronic database search performed in PubMed/MEDLINE and Scopus databases for full texts, and International Continence Society, American Urology Association, and European Association of Urology abstracts for citations related to urethral structure. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. RESULTS: A total of 316 articles were identified, 48 of which were selected for this review. Different strategies are currently being used for the management of urethral strictures, such as clean intermittent catheterization (CIC) which reduces stricture by up to 68%; direct vision internal urethrotomy which shows lower rates of renarrowing; urethroplasty which shows a success rate up to 70%; urinary diversion is the treatment of choice when reconstruction is not possible. CONCLUSIONS: Further studies are needed in this population because of the heterogeneity of the outcomes and the lack of a standardized definition and classification of this population.

[Application of patient-reported outcome measures in the diagnosis and treatment of male urethral stricture: An update].

Urethral stricture is a common and recurrent male disease, and its treatment has been shifted from endoscopic management to urethroplasty, which has greatly improved the success rate of treatment. However, patients and doctors often have different evaluations of the sexual function and lower urinary tract symptoms after urethroplasty, which has attracted the attention of researchers. In recent years, specific questionnaires or scales have been used to evaluate the effects of preoperative and postoperative treatment, laying more stress on the subjective feelings of the patients. Such questionnaires or scales are called patient-reported outcome measures (PROM). This article reviews the application of PROM in recent studies of urethral stricture, focusing on sexual function and lower urinary tract symptoms, aiming to provide some reference for the development and application of PROM in the diagnosis and treatment of male urethral stricture.

Single-surgeon experience of excision and primary anastomosis for bulbar urethral stricture: analysis of surgical and patient-reported outcomes.

PURPOSE: To report our experience with excision and primary anastomosis (EPA) for bulbar urethral stricture. METHODS: Patients who underwent EPA for bulbar stricture between 2012 and 2019 were retrospectively analyzed (n = 308). Successful urethroplasty was defined as the absence of the need for additional treatment. For follow-up, uroflowmetry was performed and the patients completed the validated Urethral Stricture Surgery Patient-reported Outcome Measure and Sexual Health Inventory for Men (SHIM) questionnaires before (baseline) and 6 months after EPA. Overall patient satisfaction after urethroplasty was also evaluated. RESULTS: Urethroplasty was successful in 97.1% of patients (n = 299) with a median follow-up of 37 months. A total of 215 patients (69.8%) completed the questionnaires at 6 months postoperatively. The mean maximum flow rate, lower urinary tract symptom (LUTS)-total score, Peeling's picture score, LUTS-specific quality of life, and EuroQol-visual analog scale scores improved significantly from 7.7 ml/s, 11.6, 3.3, 2.4, and 58.0 at baseline to 24.1 ml/s, 2.7, 1.9, 0.4, and 82.1 postoperatively (p < 0.0001 for all comparisons). However, five-point or greater deterioration in the SHIM score was found in 41 patients (19.1%). Regarding patient satisfaction, 98.6% of patients (212/215) were "satisfied" (32.6%) or "very satisfied" (66.0%) with the outcome. A low postoperative LUTS-total score and Peeling's picture score were independent predictors of a "very satisfied" patient (p = 0.001 and p = 0.01, respectively). CONCLUSIONS: EPA had a high success rate and was associated with significant benefits in both subjective and objective outcomes. Contrarily, a high incidence of postoperative erectile dysfunction was observed.

Advancements in transurethral management of urethral stricture disease.

PURPOSE OF REVIEW: To explore and report the recent evolution of transurethral management of urethral stricture disease. RECENT FINDINGS: In recent years, new promising techniques in the transurethral management of urethral stricture disease have emerged including adjuvant therapies to direct vision internal urethrotomy, regenerative therapy with buccal mucosa cells and minimally invasive transurethral urethroplasty procedures that avoid skin incisions. SUMMARY: Although further work is needed, the expanding field of transurethral therapies for urethral stricture disease demonstrates early promising results through a variety of modalities.

Update on the management of penile and meatal strictures.

PURPOSE OF REVIEW: Treatment of penile and distal urethral strictures including the fossa navicularis and the meatus remains challenging due to their adverse etiology and lack of ventral tissue support. In this contemporary review, we summarize the available evidence and recent advancements in reconstructive techniques. RECENT FINDINGS: Over the last years, several refinements of already established techniques have been added to the reconstructive armamentarium in the management of penile urethral strictures. These include the single-stage combination of flap and graft, the additional use of tissue glue, or an optimized single-stage tubularization using a free graft. SUMMARY: There is a shift toward an increased use of single-stage procedures even in complex strictures of the penile and distal urethra. This is reflected by advancements and refinements in operative techniques. Nonetheless, staged urethroplasty remains a cornerstone of curative management in such patients with durable success rates. Future research should focus on identifying distinct patient and stricture characteristics to determine the individual therapeutic approach with optimal functional outcomes.

Update on the management of complex strictures of the bulbar urethra.

PURPOSE OF REVIEW: This narrative review summarizes the most relevant literature published in 2019-2020 regarding urethroplasty for bulbar strictures. RECENT FINDINGS: We identified relevant papers focussing on new insights in the field of excision and primary anastomosis, graft augmentation urethroplasty and perineostomy for bulbar strictures and bulbomembranous strictures after radiotherapy or surgery for benign prostatic hyperplasia. SUMMARY: Respecting the vascularity of the anterior urethra and maintaining the integrity of surrounding structures during bulbar urethroplasty does not appear to deteriorate surgical outcomes and might be associated with improved functional outcomes.

Diagnosis and treatment of anterior urethral strictures in China: an internet-based survey.

BACKGROUND: To investigate the current diagnostic and therapeutic approaches to anterior urethral strictures of Chinese urologists and to compare with developed countries and the American Urologic Association guidelines. METHODS: Anonymous questionnaires were distributed to members of Official Wechat Account of urology from March 19, 2020 to April 10, 2020. Descriptive and multiple correspondence analysis were used to analyze the data. RESULTS: A total of 1276 online questionnaires were received. The response rate was 21.7% (1276/5878). The most common diagnostic methods for anterior urethral stricture were urethrography (90.7%) and urethrocystoscopy (85.4%), while urethral dilation (92.3%) and internal urethrotomy (60.1%) were the main therapeutic procedures. End-to-end urethroplasty (45.2%) was the most common open surgery, followed by skin flap urethroplasty (14.9%) and free graft urethroplasty (12.4%). 76.2% of urologists used urethroplasty only after the failure of minimally invasive surgery (reconstructive ladder treatment strategy). Furthermore, middle-aged or elderly urologists who had attended trainings, had senior practice roles, and who utilized a reconstructive ladder treatment approach were most likely to perform urethroplasties. CONCLUSIONS: Anterior urethral stricture treatment in China is still dominated by minimally invasive surgery, with most urologists using the reconstructive ladder treatment strategy. In general, the overall diagnostic and therapeutic strategies were similar between China and developed countries, with some deviations from the American Urologic Association guidelines.

Safety and Efficacy of Trans-Perineal Urethroplasty for Management of Post-Traumatic Urethral Strictures in Pediatric Age-Group.

INTRODUCTION: Trans-perineal urethroplasty is the preferred treatment for distraction urethral injuries in adults. However, management of such injuries in children is challenging because of functional implications in a growing child. In the present study, we aim to evaluate the safety and efficacy of perineal urethroplasty for distraction urethral injuries in children. METHODS: The medical records of prepubertal pediatric patients (age <14 years) with traumatic urethral distraction injuries managed by perineal urethroplasty were retrospectively reviewed and analyzed with respect to demographics, stricture characteristics, management, complications, follow-up, and outcome. RESULTS: A total of 14 patients were included in the study. Ten had membranous, and 4 had bulbar urethral strictures. All membranous strictures were secondary to pelvic trauma; bulbar strictures were secondary to blunt perineal trauma; 7 patients had associated pelvic fractures. Anastomotic urethroplasty was used in 10 patients (71.4%) and buccal mucosal graft urethroplasty was done in 4 patients (38.6%). The mean follow-up duration was 56 months (range 24-76). Surgery was primarily successful in 85.7%. Failed repair in 2 patients was successfully managed with augmented anastomotic urethroplasty. Post-operatively, the mean maximal urinary flow rate was 26.4 mL/s. No significant complications occurred. All boys are continent. There was no chordee or urethral diverticula, during follow-up. CONCLUSION: In pediatric patients, bulbar and membranous strictures can be treated successfully with urethroplasty using the perineal approach. Longer follow-up is needed to confirm that these good results are maintained as these patients cross into adulthood, especially as these repairs were done before puberty.

[A comprehensive approach to the treatment of urethral strictures caused by lichen sclerosus].

AIM: to evaluate the correctness of the diagnosis of lichen sclerosus with an evaluation of complications in the form of urethral strictures and to ensure long-term monitoring of patient management in order to avoid recurrence of fibrous complications and ascending infection in case of lower urinary tract obstruction. MATERIAL AND METHODS: a total of 55 men aged from 17 to 85 years with lichen sclerosus complicated by urethral stricture who were treated from 2005 to 2020 were included in the study. All patients underwent a comprehensive urological examination. From them, 18 (32.7%) patients had previously undergone various types of urethral procedures and were admitted with recurrent urethral stricture for repeated surgery. RESULTS: an examination of patients with lichen sclerosus complicated by urethral strictures is presented, including a morphological assessment of the resected tissue and analysis of etiopathogenetic factors. In addition, the results of complex treatment of patients with urethral strictures associated with sclerosus were evaluated. An increase in the maximum urine flow rate and a decrease in post-void residual volume by almost three times was noted 1-3 months after urethroplasty. After 6 months, a recovery of an adequate micturition and complete absence of residual urine were revealed. The morphological picture in patients with urethral strictures associated with lichen sclerosus is characterized by focal atrophy of the epidermis, replacement of the columnar epithelium with a stratified epithelium with signs of hyperkeratosis and acanthosis, histiolymphocytic infiltration, and the formation of microcalcifications under the basement membrane. CONCLUSION: the correctness of the diagnosis verification and the choice of the treatment strategy in patients with urethral strictures caused by lichen sclerosus significantly contributes to the favorable outcomes. Based on comparative analysis, we can conclude than complex approach to the treatment of patients with urethral strictures associated with lichen sclerosus is highly effective.

The outcomes of Kulkarni's one-stage oral mucosa graft urethroplasty in patients with panurethral stricture: a single centre experience.

PURPOSE: To present the results of our one-stage oral mucosa graft urethroplasty series for panurethral strictures. METHODS: We included the first 35 patients who had one stage oral mucosa graft urethroplasty with one side dissection of the urethra which was described by Kulkarni, between January 2015 and June 2018 and had at least 6 months follow-up. From the first case, all data were recorded prospectively and patient age, etiology of the stricture, comorbidities, previous treatments, postoperative maximal flow rate, pre and post-operative erectile function, perioperative and postoperative complications and quality of life questionnaire for this study. RESULTS: The mean patient age was 58.8 and mean stricture length was 13.6 (10-16) cm. Patients had previously 1-17 procedures. Patients had a mean peak flow rate of 25.4 ml/sec at the first postoperative visit. During the follow-up period, six patients had recurrence and managed with urethral dilation (1), direct vision internal urethrotomy (2), meatoplasty (1) and re-urethroplasty (2). The responses to the questions about satisfaction from the surgery showed that 31 (88.6%) patients were satisfied with the surgery, 33 (94.3%) would prefer this procedure again, if needed, and 31 (88.6%) patients recommended this procedure to others. When patients were grouped according to age, recurrence rate was 35.7% in patients older than 65 years and 4.8% in patients ≤ 65 years old. CONCLUSIONS: Our study showed that Kulkarni's one-stage oral mucosa graft urethroplasty technique has a high success rate. The patient satisfaction is high because of the good functional outcomes and low complication rate.

The Importance of Cystoscopy in Diagnosis and Treatment of Urethral Stricture Following Transurethral Prostatectomy.

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.

[Urethral strictures: a variety of treatments requiring regular practice]. / Sténoses urétrales : une variété de traitements nécessitant une pratique régulière.

Urethral stricture is defined by a decrease in the caliber of the urethral lumen which can cause a decrease or an interruption of the urine flow. This disease is much more common in men than in women, and several causes can be identified. The diagnosis depends on a careful patient history focusing on obstructive and/or irritative lower urinary tract symptoms and is confirmed by a specific work-up. Treatment ranges from conservative management to open surgery and requires specialized surgeons, so as an adequate technical platform. The evolution of surgical techniques has fortunately significantly increased long term success rates. Hence, the classical saying heard about the outcome of urethral stenosis treatment : « once a stricture, always a stricture ¼ is no longer the rule.

La sténose urétrale est définie comme une diminution du calibre de la lumière urétrale qui peut engendrer une diminution du flux urinaire. Cette pathologie est plus fréquente chez l'homme et on l'attribue à de nombreuses causes. Le diagnostic dépend d'une bonne anamnèse, marquée essentiellement par des troubles mictionnels obstructifs et/ou irritatifs, et est confirmé par des examens complémentaires spécifiques. Le traitement peut aller de la prise en charge conservatrice à la chirurgie ouverte, et requiert toujours des chirurgiens spécialisés ainsi qu'un plateau technique adéquat. Ces 25 dernières années, le développement des techniques chirurgicales a permis d'augmenter le taux de succès, ce qui contredit l'adage classique du milieu du siècle dernier : « once a stricture, always a stricture ¼.