Contemporary Management of Bulbar Urethral Strictures

Ross S Liao; Erica Stern; James E Wright; Andrew J Cohen

Contemporary Management of Bulbar Urethral Strictures

Rev Urol. 2020;22(4):139-151.

Authors

Ross S Liao¹, Erica Stern¹, James E Wright¹, Andrew J Cohen¹

Affiliation

¹ Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.

PMID: 33927571
PMCID: PMC8058922

Abstract

Urethral stricture disease (USD) is a progressive scar-forming disease commonly encountered by urologists and is challenging to manage. USD most frequently occurs in the bulbar urethra. Patients typically present with chronic obstructive voiding symptoms but may develop recurrent urinary tract infections, detrusor failure, or renal disease. The authors review the pathophysiology, diagnostic workup, and evidence-based management of bulbar urethral strictures (BUS). There are multiple surgical options to treat BUS. Endoscopic techniques (eg, dilation and urethrotomy) are suitable for the initial management of short strictures but new evidence-based guidelines recommend against repeated endoscopic treatment. Urethroplasty is the gold standard treatment for BUS of all lengths, with anastomotic techniques appropriate for strictures <2 cm and tissue substitution performed for longer strictures. New techniques, such as non-transecting urethroplasty, lack long-term data but may represent a paradigm shift in the field. Future treatments may utilize tissue-engineered grafts and agents that inhibit inflammation and scar formation.

Keywords: Buccal graft, non-transecting; Bulbar urethral stricture; Urethral dilation; Urethroplasty; Urethrotomy.