How to cite: Sukumar, Shyam S. “Challenges in the Management of Urethral Stricture Disease.” September 19th, 2025. Accessed Nov 2025. https://grandroundsinurology.com/challenges-in-the-management-of-urethral-stricture-disease/
Shyam S. Sukumar, MD, Associate Professor of Urology, Baylor College of Medicine, Houston, Texas, reviews the classification, diagnostic workup, and management of urethral stricture disease. He distinguishes between focal or acute strictures and diffuse urethral stricture disease, with etiologies evenly divided among iatrogenic, idiopathic, inflammatory, and traumatic causes.
Dr. Sukumar outlines minimally invasive approaches such as direct visual internal urethrotomy (DVIU) and balloon dilation. He notes that while endoscopic methods may be appropriate for short, first-time bulbar strictures, long-term success rates are low and repeat procedures should be avoided. For strictures longer than 2 centimeters or recurrent disease, reconstructive urethroplasty should be considered.
Reconstructive options include excision and primary anastomotic (EPA) urethroplasty and substitution urethroplasty using buccal mucosa. Dr. Sukumar explains techniques for achieving tension-free anastomosis, and discusses complex cases, such as post-hypospadias stricture and pelvic fracture injuries.
Dr. Sukumar asserts that urethroplasty provides superior long-term outcomes and that intraoperative adaptability is essential for optimal results.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as management of upper tract cancer and prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Sukumar presented this talk at the 2025 conference.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Shyam S. Sukumar, MD, is an associate professor in the Scott Department of Urology at the Baylor College of Medicine in Houston, Texas. Dr. Sukumar graduated from Kilpauk Medical College in Chennai, India, in 2009. He completed his urology residency at the University of Minnesota in Minneapolis and his fellowship in genitourinary reconstruction at Columbia University in New York, under the leadership of Dr. Steven Brandes. Dr. Sukumar’s clinical and research interests are centered on reconstructive urology including urethral stricture disease, male voiding dysfunction and urinary incontinence, genitourinary fistula, and upper tract reconstruction.
