Urethral Stricture Flashcards
What are some possible symptoms of urethral stricture?
weak urine stream, incomplete bladder emptying, dysuria, spraying, erectile dysfunction, ejaculatory dysfunction
female - LUTS, recurrent UTI, hesitancy, poor flow, frequency, urgency
What are risk factors for urethral stricture?
hypospadias repair, prior cauterization or transurethral surgery, prostate CA treatment, traumatic injury
If stricture is suspected, what studies can you do?
UA, PVR, uroflow, cysto, RUG, VCUG, US uretherography
can sometimes consider MRI
What must you know prior to intervention?
length and location
If emergent, what should be performed?
SPT vs dilation over a wire vs DVIU
How long should you allow for urethral rest?
4-6 weeks, SPT if patient is unable to void
What are options for a short <2cm bulbar urethral stricture?
DVIU (35-70%), urethral dilation, or urethroplasty (70-90%).
urethroplasty has a higher success rate, but more risks associated with surgery
Can you inject agents?
There are a few studies showing steroids and mitomycin C may help
If CIC is to be performed, how long should it be done post DVIU to maintain patency?
> 3 months
weekly vs daily
Recurrent strictures , what is recommendation?
Urethroplasty
BUT if recurrent bulbar < 3 cm, can consider optilume. no data to suggest for penile urethra yet
83% with optilume vs 20% vs DVIU alone
What are things to be careful about with optilume?
Do not try to conceive within six months afterwards. SE include hematuria or dysuria
What are initial treatments for meatal or fossa novicularis strictures?
Dilation or meatotomy
Failed or recurrent = urethroplasty
When can you not do these for meatal or FN strictures?
previous hypospadias repair, prior failed endoscopic management, prior urethroplasty, LS
What is treatment for penile urethra?
Preferred is urethroplasty - single or two staged
What is treatment for long bulbar urethral stricture?
urethroplasty
What about panurethral strictures?
consideration for perineal urethrostomy or urethroplasty with grafts
What are reasons for perineal urethrostomy?
recurrent strictures
sit to void
buried penis
multiple comorbidies
complex strictures
LS
poor access to urologic care
For a patient with a PFUI - what do you need prior to surgery?
RUG, VCUG, retrograde vs antegrade cystoscopy - make sure bladder neck is open
What artery must you preserve in a urethroplasty?
bulbar artery
If you need more length on a urethroplasty, what do you do (bulbar)?
mobilize the bulbar urethra, separate the crura, inferior pubectomy, supracrural routing
What is LS a risk for?
squamous cell carcinoma progression. Patients tend to have a higher BMI, HTN, DM, CAD, and have longer urethral strictures
thus must consider a biopsy
avoid using entail skin flaps / grafts
How and how often should patients with urethral strictures be followed?
Timing is patient dependent - but should use a combination of cystoscopy, RUG, or urethral ultrasound
What are risks of urethroplasty?
Recurrence, ejaculatory dysfunction, erectile dysfunction, chordee, penile sensation deficits
