Elsevier

Urology

Volume 81, Issue 1, January 2013, Pages 191-197
Urology

Reconstructive Urology
Contemporary Urethral Stricture Characteristics in the Developed World

https://doi.org/10.1016/j.urology.2012.08.062Get rights and content

Objective

To assess the current etiology, features, and natural history of urethral stricture disease in the developed world.

Materials and Methods

We analyzed the data from 1439 male patients with urethral stricture, who had undergone surgical treatment in our referral urethral center from 2000 to 2010. The preoperative evaluation included a detailed clinical history of stricture, uroflowmetry, retrograde and voiding cystourethrography, and urethroscopy. Statistical analysis was done for the stricture site, length, and etiology, patient age, and previous treatments.

Results

Strictures were posterior in 112 (7.8%) and anterior in 1327 (92.2%). In the anterior group, 439 were penile (30.5%), 675 bulbar (46.9%), 71 penile plus bulbar (9.9%), and 142 panurethral (4.9%). The main causes were iatrogenic in 556 (38.6%), unknown in 515 (35.8%), lichen sclerosus in 193 (13.4%), and trauma in 156 (10.8%). The main iatrogenic strictures were from catheterization in 234 (16.3%), hypospadias repair in 176 (12.2%), and transurethral surgery in 131 (9.1%). The stricture distribution increased until about 45 years and then decreased. Strictures were uncommon in those <20 and >70 years old. The mean length was 4.15 cm; longer strictures were found in those with lichen sclerosus (7.45 cm) or after hypospadias repair (4.42 cm) and catheterization (4.40 cm). The mean length was also greater in the pretreated (4.34 cm) than in the untreated (3.64 cm) strictures.

Conclusion

Urethral stricture in developed countries mainly involves the anterior urethra, in particular the bulbar tract. The most common cause was iatrogenic. Hypospadias repair and lichen sclerosus represent emerging important causes. Finally, urethral stricture is not a disease of the elderly but involves all ages.

Section snippets

Material and Methods

A retrospective study was performed in our Italian referral center for urethral reconstruction to analyze the whole database of male patients with urethral stricture who had undergone surgical treatment from 2000 to 2010, regardless of age.

A total of 1439 patients were diagnosed, evaluated, and surgically treated by the same urologist (E.P.). The preoperative evaluation included a detailed clinical history of the urethral stricture disease, physical examination, uroflowmetry, retrograde and

Results

Of the 1439 patients, 1402 (97.4%) underwent urethroplasty and 37 (2.6%) internal urethrotomy. The main characteristics of the study data set are listed in Table 1.

Most Common Stricture Site

Our findings have confirmed that urethral stricture in developed countries mainly involves the anterior urethra (92.2%), in particular, the bulbar tract (46.9%), with the posterior urethra involved only in 7.8% of cases.5, 6, 8 This explains why general urologists manage mainly bulbar strictures and, more rarely, penile strictures. The rarest posterior strictures are treated in highly specialized centers.7

Current Most Common Stricture Etiology

Past reports on stricture etiology have been characterized by small series of patients.

Conclusion

Our findings have shown that urethral stricture in developed countries mainly involves the anterior urethra, in particular, the bulbar tract. The most common cause of stricture formation was iatrogenic; thus, particular care must be taken when handling the urethra. HR and LS represented important emerging causes, responsible for most penile and panurethral strictures, which are also commonly acknowledged as the most difficult to treat. Finally, urethral stricture is not a disease of the elderly

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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