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Male urethral strictures and their management

Key Points

  • Male urethral strictures are common and have a significant impact on a patient's quality of life and health-care costs

  • Studies such as retrograde urethrography, voiding cystourethrography, and intraoperative ultrasonography can be helpful for determining the best operative approach and management plan

  • Urethral dilation and internal urethrotomy have similar rates of success, with long-term success rates of 20–30%

  • Repeated internal urethrotomy is not clinically effective or cost-effective

  • Long-term success rates are high for urethroplasty, generally ranging from 85–90%

Abstract

Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8–80%, with long-term success rates of 20–30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85–90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.

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Figure 1: Stricture pathogenesis.
Figure 2: Imaging for stricture.
Figure 3: Algorithm of general strategy for surgical management of common presenting problems in men with previous hypospadias treatment.

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L. A. Hampson and B. N. Breyer researched the literature for this article. L. A. Hampson wrote the article, discussed the article with colleagues, and edited the final manuscript. B. N. Breyer and J. W. McAninch contributed towards discussions of contents and reviewed the manuscript prior to publication.

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Correspondence to Lindsay A. Hampson.

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Hampson, L., McAninch, J. & Breyer, B. Male urethral strictures and their management. Nat Rev Urol 11, 43–50 (2014). https://doi.org/10.1038/nrurol.2013.275

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