Urethral Stricture in the Spinal Cord Injured Patient—What Are the Unique Considerations?

Urethral stricture disease in spinal cord injured (SCI) patients presents a challenging clinical scenario. Determining the appropriate course of management requires consideration of the unique issues of these patients, and unfortunately there is sparse published literature. The goals of treatment should be determined before the treatment modality is chosen. Endoscopic management options such as direct visual internal urethrotomy (DVIU), although less invasive, have a very high recurrence rate compared to urethral reconstruction or urinary diversion. Catheterization, whether clean intermittent catheterization (CIC), suprapubic catheter (SPC), or indwelling catheter (IDC), is often problematic. Urethral strictures in SCI patients are usually best treated with urethral reconstruction or urinary diversion. However, urethral reconstruction is associated with a significant rate of reoperation and subsequent necessity for urinary diversion; therefore, urinary diversion may be most appropriate in many patients. Detailed discussion and consideration of unique patient factors as well as patient preferences are important components of preoperative counseling.