Innovative Approaches for Complex Penile Urethral Strictures

Jordan Siegel; Timothy J. Tausch; Jay Simhan; Allen F. Morey

Disclosures

Transl Androl Urol. 2014;3(2):179-185. 

In This Article

Abstract and Introduction

Abstract

Urethral strictures are a common urologic disease that arises from varied etiologies. These strictures range in severity from simple, short lesions to complex, long defects. Likewise, the management approach varies based on the complexity of the lesion. We reviewed the literature of urethral stricture disease and its management. In particular we have focused on complex strictures of the male penile urethra. Often these cases cannot be managed with traditional reconstructive techniques and require newer approaches. Furthermore tissue engineered graft materials provide a possible tissue source for future reconstructive endeavors.

Introduction: Etiology and Demographics

Patients with strictures have been shown to account for a sizable burden on the healthcare system with 1.5 million office visits over an 8-year period in addition to 5,000 inpatient visits annually. The economic impact is significant as well, with an estimated annual cost of around $191 million in the year 2000.[1]

Strictures of the anterior urethra are most common, accounting for 92% of cases. Within the anterior urethra, bulbar strictures occur most often (46.9%), followed by penile (30.5%) and combined bulbar/penile (9.9%).[2] The etiology of urethral strictures is highly variable and largely depends on stricture location. Penile urethral strictures are most commonly caused by inflammatory conditions (40%), such as lichen sclerosis, and iatrogenic injury (40%). In contrast, an idiopathic etiology is most commonly observed in cases of bulbar disease (40%), followed by iatrogenic (35%) and inflammatory causes (10%).[2] Urethral trauma accounts for 5% of all penile strictures and 15% of bulbar strictures in the industrialized world. However, trauma accounts for a much higher percentage of overall strictures in the developing world, secondary to blunt pelvic trauma and gunshot wounds.[3] In these cases, posterior urethral injury is often observed.

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