Maxx Gallegos, MD, presented “Urethral Stricture Management in the 21st Century: Treatments for Even the Worst Urethras” during the 23rd Annual Innovations in Urologic Practice on September 14, 2018 in Santa Fe, New Mexico.
How to cite: Gallegos, Maxx. “Urethral Stricture Management in the 21st Century: Treatments for Even the Worst Urethras” September 14, 2018. Accessed [date today]. https://grandroundsinurology.com/urethral-stricture-management-in-the-21st-century-treatments-for-even-the-worst-urethras/
Urethral Stricture Management in the 21st Century: Treatments for Even the Worst Urethras – Summary:
Maxx Gallegos, MD, reviews traditional urethral stricture management techniques, specifically direct visualization internal urethrotomy (DVIU) and dilation. He then discusses new and emerging techniques, especially urethroplasty, that may better benefit these patients.
With the advent of the American Urological Association (AUA) Guidelines on urethral stricture disease, urethral stricture management is likely to change (1). Historically, the management of urethral strictures has been an endoscopic approach with either DVIU or dilation. In the past, urologists generally thought these treatments had acceptable success rates (2). More contemporary data shows that endoscopic treatments for urethral strictures are not initially successful, and never successful thereafter (3).
Definitive repair via urethroplasty will likely increase in utilization with success rates between 88% and 95% (4). Selecting which type of urethroplasty to offer a patient can be difficult. Therefore, fluoroscopic, and sometimes endoscopic, preoperative evaluation is necessary (1). In the penile urethra, most experts advocate for substitution urethroplasty with buccal mucosa (1). The new technique of transurethral ventral onlay for meatal and fossa navicularis strictures has so far demonstrated durable success (5).
In the bulbar urethra, there are multiple acceptable techniques for urethral strictures less than or equal to 2cm. However, there is controversy as to which technique is most efficacious with the least complications (4). For strictures greater than 4cm in the bulbar urethra, the use of double-sided buccal grafts is very effective (6,7). For panurethral strictures, Sanjay Kulkarni, MBBS, MS, FRCS, of Pune, India has pioneered an effective technique involving the invagination of the penis through a perineal incision, a unilateral dissection of the urethra, and a dorsal onlay buccal graft (8,9). Management of this condition is evolving, with novel techniques continually emerging, to the benefit of our patients, even those with the most complex urethral strictures.
About Innovations in Urologic Practice
Innovations in Urologic Practice (IUP) is an annual CME-accredited conference devoted to updating urologists on the rapidly changing healthcare environment. Topics focus on innovative diagnostic and treatment strategies, controversies, new and currently developing technologies, and challenges in today’s urologic practice. Dr. Gallegos presented this lecture during the 23rd IUP in 2018. Please visit this page in order to learn more about future IUP meetings.
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- Kulkarni SB, Kulkarni JY, Kirpekar DV. A new technique of urethroplasty for balanitis xerotica obliterans. J Urol. (Suppl). 2000;163:352; (abstract V331).
- Kulkarni SB, Joshi PM, Venkatesan K. Management of panurethral stricture disease in India. J Urol. 2012;188:824-830.