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  • Review Article
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Complicated urethroplasty: a guide for surgeons

Nature Reviews Urology volume 7, pages 521–528 (2010)Cite this article

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Abstract

Although straightforward male urethral stricture disease is commonly encountered in the scope of general urologic practice, complex urethral strictures are less common and require a more systematic approach. Complex urethral stricture surgery for long and panurethral strictures, after failed hypospadias repair, and for recurrent posterior urethral distraction defects requires a dynamic treatment paradigm. A multistaged urethral reconstruction is often necessary owing to hostile urethral tissue, especially after multiple previous procedures. A perineal urethrostomy sometimes offers improved quality of life for patients with complex urethral stricture disease, particularly if they have undergone previous failed repairs. Recurrent posterior urethral distraction defects are best treated with excision of the scarred urethral segment and re-anastomosis. Urethral stricture disease after treatment for prostate cancer requires multiple treatment approaches given the often poor tissue quality and likelihood of stricture recurrence.

Key Points

  • Complex urethral stricture surgery after failed hypospadias repair, for long and panurethral strictures, and for recurrent posterior urethral distraction defects requires a dynamic treatment paradigm

  • Urethral reconstruction often requires a multistaged approach, rather than a single-stage operation, owing to hostile urethral tissue, especially after multiple previous procedures

  • A perineal urethrostomy sometimes offers improved quality of life for patients with complex urethral stricture disease, particularly those who have undergone previous failed repairs

  • Recurrent posterior urethral distraction defects are best treated with excision of the scarred urethral segment and reanastomosis

  • Urethral stricture disease after treatment for prostate cancer requires multiple treatment approaches given the often poor tissue quality and likelihood of stricture recurrence

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Figure 1: Johanson urethroplasty for urethral stricture after childhood hypospadias repair.
Figure 2: Fasciocutaneous flap urethroplasty.
Figure 3: Two-stage Johanson urethroplasty for panurethral stricture.
Figure 4: Perineal urethrostomy.
Figure 5: Anastomotic urethroplasty for stricture caused by prostate brachytherapy, affecting the prostatic apex, membranous urethra, and proximal bulbar urethra.
Figure 6: Management algorithm for anterior urethral strictures after prostate cancer treatment.
Figure 7: Management algorithm for posterior urethral strictures after prostate cancer treatment.

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Author information

Authors and Affiliations

  1. William Beaumont Hospital, 3535 W. 13 Mile Road, Royal Oak, 48073, MI, USA

    Frank N. Burks

  2. The Detroit Medical Center and Michigan State College of Osteopathic Medicine, Harper Professional Building, Suite 1017, Detroit, 4160 John R, 48201, MI, USA

    Richard A. Santucci

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  1. Frank N. Burks
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Contributions

F. N. Burks and R. A. Santucci both made substantial contributions to researching data for the article, discussing the content, writing the article and reviewing the manuscript before submission.

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Correspondence to Richard A. Santucci.

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The authors declare no competing financial interests.

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Burks, F., Santucci, R. Complicated urethroplasty: a guide for surgeons. Nat Rev Urol 7, 521–528 (2010). https://doi.org/10.1038/nrurol.2010.118

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