Historical Perspective and Innovations in Penile Urethroplasty

Abstract

Penile urethral strictures are common and impact on quality of life and healthcare costs. Management of penile urethral strictures is complex and depends on the physical characteristics of the stricture. Contemporary studies show no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes. Overall, long-term success rates range from 20 to 30%. However, their recurrence rate is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures, which make them less cost-effective. Surgical urethroplasty is associated with higher long-term success rates, averaging from 85 to 90%, mostly in virgin or noncomplex cases. Historically, modern urethral reconstruction has evolved from 1950s with the revolutionary introduction of Johanson's technique for staged urethral reconstruction. Since then, many techniques have been developed and employed for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.

Analysis of the Physico-Chemical, Mechanical and Biological Properties of Crosslinked Type-I Collagen from Horse Tendon: Towards the Development of Ideal Scaffolding Material for Urethral Regeneration

“…Endoscopic dilatation has a success rate of 50-60% for short strictures, a percentage that decreases at approximately 20% in the case of strictures longer than 2 cm [1]. The reason why urethral endoscopic dilation is not effective is that it implies the rupture of the urethral mucosa and subsequent urine diffusion in the created defect, which further nourishes an inflammatory response resulting in the formation of scar tissue [11]. Anastomotic urethroplasty, which has the highest success rate (93%) [11], is burdened by the risk of excessive tension on the penis, which may cause chordee or curvature and may impact erectile function [12].…”

One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis

“…5 Ventral grafts, particularly when used in the penile urethra, have previously been shown to result in worse outcomes than dorsal grafts. 2,37,38 The small caliber and poor vascularization of the ventral spongiosum may compromise graft take. 2,37,38 Only a limited number of studies published in the literature describe utilizing a ventral graft, in any portion of the urethra, for 1-stage urethroplasty in patients with LS.…”

“…2,37,38 The small caliber and poor vascularization of the ventral spongiosum may compromise graft take. 2,37,38 Only a limited number of studies published in the literature describe utilizing a ventral graft, in any portion of the urethra, for 1-stage urethroplasty in patients with LS. Hudak et al utilized overlapping dorsal and ventral BMGs in 7 LS patients and reported a 0% recurrence rate.…”

“…5 Ventral grafts, particularly when used in the penile urethra, have previously been shown to result in worse outcomes than dorsal grafts. 2,37,38 The small caliber and poor vascularization of the ventral spongiosum may compromise graft take. 2,37,38…”

“…2,37,38 The small caliber and poor vascularization of the ventral spongiosum may compromise graft take. 2,37,38…”