Urethroplasty: Effective Surgical Management for Male Urethral Strictures

Urethral stricture, the narrowing of the urethra due to scarring, is a common cause of urinary obstruction in men aged 20–40 and affects around 0.5% of the UK population. Symptoms often include weak urinary stream, incomplete bladder emptying, urinary tract infections, and sexual dysfunction. Strictures are mostly found in the anterior urethra, particularly the bulbar urethra, and can result from trauma, iatrogenic injury, infections, inflammatory conditions, or congenital issues. About 30% of cases are idiopathic.

Traditional management includes endoscopic methods such as urethral dilatation or urethrotomy, but these carry high recurrence rates, up to 60%, and poor long-term outcomes. Urethroplasty, or open surgical reconstruction of the urethra, has emerged as the gold standard, especially for recurrent or complex strictures. Techniques include anastomotic urethroplasty, where the narrowed segment is excised and the urethra joined end-to-end, and augmentation/substitution urethroplasty using grafts such as buccal or lingual mucosa. Anastomotic urethroplasty has success rates of 95–99%, while graft-based repairs vary from 65–87%, influenced by stricture length, location, and surgical method.

Postoperative care involves catheter management, urethrograms to assess healing, urodynamic testing, and management of co-morbidities. Common complications include swelling, bruising, donor site discomfort, and less commonly, erectile dysfunction or fistula formation. Stricture recurrence is lower than with endoscopic methods, making urethroplasty a reliable long-term solution.

Although urethroplasty shows excellent outcomes, no universal guidelines exist for technique selection, highlighting the need for individualized treatment decisions. Ongoing studies, such as randomized controlled trials comparing urethroplasty with repeat endoscopic procedures, will help refine treatment recommendations and optimize care for men with urethral stricture.

Thompson, C., Trail, M., & Alhasso, A. (2018, March 1). Urethroplasty: A review of indications, techniques and outcomes. Urology News. https://www.urologynews.uk.com/features/features/post/urethroplasty-a-review-of-indications-techniques-and-outcomes