Reconstructive Urology

1. URETHRAL STRICTURES
11TH
JUNE,2014
DR. P. MUSAU
MBChB, MMed (Surg), MSc (Urol)

2. URETHRAL STRICTURES..
OUTLINE OF TOPIC
• DEFINITION:
• AETIOLOGY:.
• PATHOPHYSIOLOGY:
• PRESENTATION:
• MODES OF TREATMENT.

3. URETHRAL STRICTURES
• DEFINITION:Pathological, Technical
• AETIOLOGY: Congenital, Acquired
-Ischaemia, infection, inflammation, trauma
• PATHOPHYSIOLOGY: Scar contraction and
luminal narrowing or obliteration
• PRESENTATION:Obstructive voiding
symptoms, urinary retention and complications
e.g. UTI, bladder stones, diverticuli,
urethrocutaneous fistulas and renal failure
• PRESENTATION:• PRESENTATION:

4. URETHRAL STRICTURES Ctd….
• DIAGNOSIS
-History
-Examination
-Investigation
-Diagnostic procedures.

5. URETHRAL STRICTURES Ctd..
• INFORMATION
SOUGHT IN
RADIOLOGIC
INVESTIGATION
-Site(S)
-Number
-Length
-Severity
-Associated anomalies
• X-RAY FILM

6. URETHRAL STRICTURES Ctd…
• TREATMENT OF URETHRAL STRICTURES
-Dichotomy; intention to cure or palliate.
• Dependent on:
-Age of patient
-Aetiology
-Site
-Number
-Length
-Severity
-Condition of patient
-Previous interventions

7. URETHRAL STRICTURES Ctd….
• TREATMENT LADDER:
1. CONSERVATIVE MANAGEMENT:
Permanent stents, Permanent stoma/ SPC
2. POS, DVU, BALLOON DILATATION
3.ANASTOMOTIC URETHROPLASTY
4.SUBSTITUTIONAL URETHROPLASTY
5.STAGED URETHROPLASTY

8. URETHRAL STRICTURES Ctd…
• SURGERY FOR
URETHRAL
STRICTURES:
BROADLY: Primary
repair or staged repair
EITHER WAY: Does the
repair require
substitution. If YES: Is
it a graft or a flap?
IF A GRAFT, WHERE
FROM?
IF A FLAP, IS IT AN
ONLAY OR A
TUBULARISED
FLAP?

9. THE PENIS IS NORMAL
• ONE-STAGE
FLAP or GRAFT
URETHROPLASTY

10. THE PENIS IS NOT NORMAL
TWO-STAGE
GRAFT
URETHROPLASTY

11. URETHRAL STRICTURE Ctd…
• PREOP CARE:
-Ensure fit for surgery
-Ascertain mature tissues
-Eradicate infections
• INTRAOP:
-Proper handling of tissues
-Avoid haematomas
-Suture lines should not overlap
-Ensure no tension
-Adequate patency
-Stent the operation site
• POST OP:
• Tubes
• -Antibiotics
• -Re-evaluation after 4
and 12 months

12. URETHRAL STRICTURES Ctd..
• Complications:
-Bleeding/ haematomas
-UTI
-Wound infection
-Wound dehiscence
-UCF
- Recurrence: Depends on length of stricture, type
of surgery and duration since intervention. In a
year 1-2cm 40%, 2-4cm 50% and 80% for >4cm.
In 4 years, the rate increases to 75% for the 2-4
cm long.