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Management of anterior urethral stricture: an evidence-based approach

Mangera, Altaf; Chapple, Christopher

doi: 10.1097/MOU.0b013e32833ee8d5
Reconstructive surgery: Edited by Christopher R. Chapple

Purpose of review: To provide a review of the latest evidence on the management of anterior urethral strictures.

Recent findings: A continuing role exists for urethrotomy or dilatation in the management of urethral strictures as first-line therapy in selected patients. In those patients with bulbar strictures who fail or are not suitable for these procedures, an anastomotic urethroplasty, and if not feasible a substitution urethroplasty using either a flap or oral mucosal graft either by a dorsal, lateral or ventral onlay approach should be considered. For penile strictures, a ventral onlay procedure using skin can be considered except in cases of lichen sclerosis when an onlay procedure utilizing oral mucosa provides the best results using either a one-stage or two-stage approach.

Summary: Various options exist for the management of anterior urethral stricture disease. The ‘reconstructive ladder’ has served to guide urologists over the years. The selection of the correct procedure should be patient-centred and based on the latest evidence.

Sheffield Teaching Hospitals, Glossop Road, Sheffield, UK

Correspondence to Christopher Chapple, MD, Consultant Urological Surgeon, Sheffield Teaching Hospitals, Glossop Road, Sheffield S10 2 JF, UK Tel: +44 114 271 2559; fax: +44 114 279 7841; e-mail: c.r.chapple@shef.ac.uk

© 2010 Lippincott Williams & Wilkins, Inc.