How to cite: Terlecki RP. Tips on Office and Outpatient Management of Male Urethral Strictures. Grand Rounds in Urology. October 2025. Accessed Jan 2026. https://grandroundsinurology.com/tips-on-office-and-outpatient-management-of-male-urethral-strictures/
Summary
Ryan P. Terlecki, MD, FACS, Professor and Vice Chair of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, provides a practical, experience-based guide to the office and outpatient management of male urethral strictures, focusing on diagnostic accuracy, procedural technique, and appropriate patient selection. Dr. Terlecki emphasizes that while urethroplasty may not be widely performed, endoscopic and office-based management of strictures is common and often inconsistently taught.
The presentation begins with the importance of maintaining urethral stricture disease in the differential diagnosis, particularly in younger men who present with obstructive symptoms, postvoid dribbling, or recurrent diagnoses such as prostatitis or epididymitis. Dr. Terlecki explains that symptoms attributed to infection or inflammation may reflect obstruction or pelvic floor dysfunction and encourages careful interpretation of flow tracings rather than relying solely on reported values.
Diagnostic strategies are reviewed with an emphasis on retrograde urethrograms, which provide critical information on stricture length and location. Dr. Terlecki outlines limitations of cystoscopy when used in isolation and explains how anatomic features such as the external sphincter can mimic strictures. Ultrasound is discussed as having limited routine utility for most practices.
The presentation then shifts to management principles, stressing the importance of knowing when to defer treatment or refer patients for reconstructive expertise. Dr. Terlecki highlights the risks of intervening in minimally symptomatic patients and explains how treating one issue may unmask or create additional functional problems.
Detailed technical guidance is provided on dilation and direct vision internal urethrotomy. Dr. Terlecki challenges traditional teachings, including blind dilation and the routine use of the 12 o’clock incision during urethrotomy. He discusses preferred instruments, wire selection, catheter considerations, and follow-up strategies, emphasizing individualized care rather than standardized protocols.
The presentation concludes by reinforcing the need for methodical decision-making, realistic expectation setting, and timely referral when advanced care is indicated.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
ABOUT THE AUTHOR
Ryan P. Terlecki, MD, FACS, is a reconstructive urologist for Atrium Health Wake Forest Baptist Medical Center, an academic Level 1 trauma center in Winston-Salem, North Carolina. Dr. Terlecki holds the rank of Professor and the title of Vice Chair of Research for the Department of Urology. In addition, Dr. Terlecki is Director of the Men’s Health Clinic, Director of Medical Student Education, and Fellowship Director for Reconstructive Urology. He holds a joint appointment in the Department of Obstetrics and Gynecology.
Dr. Terlecki earned his medical degree from Wayne State University School of Medicine and completed residency in general surgery and urology at Detroit Medical Center. Following his residency, Dr. Terlecki completed two separate fellowships in reconstructive surgery. He completed a fellowship at the University of Colorado’s Denver School of Medicine and at UT Southwestern Medical Center in Dallas, Texas.
Dr. Terlecki’s publications cover multiple areas of trauma and reconstruction and his research is focused primarily on models of wound healing and regeneration in the lower genitourinary system. Dr. Terlecki’s areas of expertise include urethral stricture disease, male sexual dysfunction, male incontinence, Peyronie’s disease, chronic testicular pain, hypogonadism, and infertility. He is a member of the Society of Genitourinary Reconstructive Surgeons (GURS), a member of the American Urological Association (AUA), and past president of the North Carolina Urological Association (NCUA).
