Management of panurethral strictures

IntroductionPan-urethral stricture, involving the penile and bulbar urethra, is a common urological problem on the South Asian subcontinent. It represents a particularly difficult challenge to manage and there is a relative paucity of literature on the subject. In India, Lichen Sclerosus (LS) is the most common cause of pan-urethral stricture, followed by iatrogenic causes.2 stage surgery is not scientific in lichen sclerosus as this is a disease of genital skin. We present our experience of pan-urethral stricture repair using a single-stage, one-sided dissection, dorsal onlay repair with oral mucosa graft.Subjects and methodsWe retrospectively reviewed the records of 318 consecutive men undergoing management of pan-urethral stricture from June 1995 to December 2014. The median age was 44.6 years and the mean stricture length 14 cm. The median follow-up was 59 months. The strictures were approached through a perineal incision, limiting dissection to only one side of the urethra. The penis was invaginated to provide access to the entire length of anterior urethra in a single-stage, and two oral mucosal grafts were dorsally placed.ResultsThe outcome was considered a success if the patient needed no further instrumentation, including dilation or urethrotomy. The overall success rate was 84.90%, with a success rate of 89.39% in primary urethroplasty, and 57.85% in patients who had previous failed urethroplasty. Most recurrent strictures occurred at the proximal end of the graft.ConclusionsRepair of pan-urethral stricture in a single-stage, with one-sided dissection and dorsal onlay of oral mucosa, is a minimally invasive technique that is simple, fast, safe, effective and reproducible in the hand of any surgeon.