Male urethral reconstruction: an update

Abstract

Male urethral stricture is a pathologic narrowing of the anterior urethra. It is a common urologic disease and, in the Western world, mostly iatrogenic or idiopathic in nature. On validated questionnaires, which should be given out pre- and postoperatively, patients usually report a significant negative impact on their quality of life. Surgical treatment depends on etiology, location, length and texture of the stricture, as well as previous surgeries and patient preferences. Treatment options are numerous and sometimes complex. Thus, an experienced plastic reconstructive surgeon at a specialist center is required. Endourologic procedures include urethral dilatation and direct vision internal urethrotomy, which are indicated in primary short segment bulbar urethral strictures or for sail-shaped strictures without spongiofibrosis. If the patient’s general condition is good, longer (> 1 cm), multilocular, complex, recurring or penile urethral strictures should be evaluated for open urethral reconstruction. Open surgical techniques include end-to-end anastomosis, substitution urethroplasty using an (oral mucosa) graft and reconstruction with a split-thickness mesh graft or as a pedicled flap repair. Perineal urethrostomy is an alternative surgery for patients with complex penile urethral strictures and is particularly suitable for frail patients that cannot or do not wish to undergo (additional) open urethral reconstruction.