Narrative review of penile distal urethroplasties and suggestions for optimizing outcomes

Abstract

Distal urethral strictures can be a challenging entity for urologists. Endoscopic maneuvers such as optical internal urethrotomies or dilations are even less successful than in other urethral locations and the repeated trauma will increase the scarring which advocates for a urethroplasty as primary option for patient management. Success rates of distal urethroplasties have been lower than those for other urethral strictures due to the anatomy of the distal urethra with a very thin corpus spongiosum associated with decreased mucosal blood supply. Also, the high prevalence of lichen sclerosus in this population with circumferential scarring is often a complicating factor. However, in the past two decades several surgical techniques have been described and further developed which has led to significant improvement in stricture recurrence rates.Meatoplasties are indicated for strictures limited to the meatus and involve opening of the stenotic meatus with subsequent reconstruction of it to minimize spraying of urine. Often, however, distal urethral strictures involve the fossa navicularis and may even extend further proximally. These strictures can be addressed with dorsal or ventral inlay procedures using buccal mucosa graft. In addition or alternatively, skin flaps can be mobilized to increase the urethral diameter. Lastly, multi-stage urethroplasty with buccal mucosa are a very successful approach yet given the high success rates of above mentioned procedures are usually reserved for revision surgery or most severe distal urethral strictures. In the following report, we are describing a variety of surgical techniques and their indication which should allow the practicing urologist to successfully address all encountered distal urethral strictures.

Localization of external urethral orifice in coronary sulcus during urethroplasty in case of severe hypospadias accompanied by prostatic utricle cyst

“…Compliance means the tendency of an organ to resist deformation by a force [ 17 ]; obviously, encapsulation of the external orifice of the urethra by the glans cavernosum reduces urethral compliance. Furthermore, the new external urethral orifice protruded from the glans tends to form scar stricture or even atresia, and the urethral orifice stricture accounts for about 50% of the total urethral stricture after hypospadias surgery [ 18 ], Lichen sclerosus may be an important factor in distal urethral stricture [ 19 ]. This stricture can also cause increased urethral pressure, therefore, urine can more easily flow back to the testis, causing epididymitis attacks, especially in patients with hypospadias complicated with PUC.…”

Complications of primary and recurrent buccal urethroplasty in men.

“…• Локализация стриктуры. Ряд авторов отмечали, что чаще рецидивируют стриктуры пенильного отдела уретры [68,69]. Частота рецидивирования стриктур переднего отдела уретры при дорзальной onlay пластике буккальным лоскутом по данным G.A.…”

“…В то же время следует отметить, что по мере накопления опыта операций буккальной уретропластики и выбора адекватной методики операции значимость фактора протяженности стриктуры существенно снизилась. Рядом авторов получены хорошие результаты при пластике стриктур протяженностью более 10 см [61,[69][70][71].…”

Analysis of results and complications after plastic surgery of recurrent urethral strictures.

“…При этом некоторые авторы сообщают об определенных различиях [14,15]. Также актуален вопрос об осложнениях и эффективности этих операций при повторной уретропластике после неудачных первичных операций, и хотя в целом ряд авторов не находят существенных различий [16][17][18], но по отдельным вариантам операций и в зависимости от локализации стриктуры они выявляются [13,19,20].…”