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AUA guidelines > Urethral Stricture > Flashcards

Urethral Stricture Flashcards

1
Q

What is the lining of the posterior urethra?

A

Transitional epithelium

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2
Q

What is the lining of the anterior urethra?

A

pseudostratified squamous epithelium

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3
Q

What is the lining of the fossa navicularis?

A

stratified squamous epithelium

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4
Q

What is narrowing of the posterior urethra called?

A

stenosis

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5
Q

What is narrowing of the anterior urethra called?

A

stricture

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6
Q

What are the two leading causes of urethral strictures in developed countries?

A

Idiopathic 41%

Iatrogenic 35%

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7
Q

What is the leading cause of urethral stricture in developing countries?

A

Trauma 36%

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8
Q

What are the common presenting symptoms of patients with urethral strictures?

A 
Decreased urine stream
Incomplete emptying 
UTI
Epididymitis
Decreased ejaculation
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9
Q

What should be included in the workup of a patient with slow stream?

A 
Thorough history
Physical exam
UA
Urine culture
PVR
Uroflow/UDS
Cystoscopy
RUG
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10
Q

What is the duration of foley catheter placement following surgery for urethral structure?

A

Typically 2-3 weeks after which a RUG or VCUG is obtained.

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11
Q

What are the possible sexual side effects of urethroplasty?

A

Ejaculatory dysfunction 21%

Erectile dysfunction 1%

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12
Q

What is the uroflow rate associated with urethral strictures?

A

Less than 12ml/s

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13
Q

What is recommended to confirm the diagnosis of a urethral stricture?

A

Urethroscopy
RUG
VCUG
US urethography

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14
Q

What is the diagnostic of choice for confirmation of urethral stricture?

A

RUG

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15
Q

What information is required before planning treatment for a stricture?

A

Length and location of the stricture.

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16
Q

What are the treatment options when a patient is in urinary retention and has a urethral stricture?

A

Suprapubic cystostomy
Urethral dilation
DVIU

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17
Q

What should be done before definitive management for a urethral stricture if urethroplasty is being considered?

A

4-12 weeks of urethral rest with suprapubic tube if necessary to allow full stricture to declare itself.

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18
Q

What are the treatment options and success rates for bulbar urethral strictures < 2cm?

A

Dilation (35-70%)
DVIU (35-70%)
Urethroplasty (80-95%)

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19
Q

How does DVIU compare to dilation when endoscopic management is desired?

A

Dilation and DVIU may be used interchangeably

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20
Q

What is the data regarding injection of steroids or mitomycin C at time of stricture treatment?

A

There is weak evidence to suggest that it decreases recurrence rate but stronger studies with long term follow up are needed.

21
Q

When can catheters be removed safely following DVIU or dilation?

A

24-72 hours

22
Q

What is the next step in a patient who just underwent a redo DVIU but is not a candidate for a urethroplasty?

A

They should be started on self catheterization as stricture recurrence rates were significantly lower among patients performing self-catheterization (risk ratio 0.51, 95% CI 0.32 to 0.81, p = 0.004

23
Q

What is the next step in most patients who failed at least one endoscopic procedure for urethral stricture?

A

Urethroplasty

24
Q

What is the failure rate for repeat endoscopic management of urethral strictures?

A

> 80%

25
Q

What are the initial options for treatment of meatal or fossa navicularis strictures?

A

Dilation

Meatotomy

26
Q

What factors may complicate tx of fossa navicularis/meatal strictures?

A

Hypospadias repair
Failed endoscopy
Urethroplasty
Lichen sclerosis

27
Q

What initial tx can be used for meatal strictures due to LS?

A

extended meatotomy in conjunction with high-dose topical steroids

28
Q

What should be done with the patient that has recurrent meatal or fossa navicularis strictures?

A

Surgeons should offer urethroplasty.

29
Q

What is the success rate of uncomplicated meatotomy?

A

87%

30
Q

What is the most common method of repair for the fossa navicularis?

A

Penile fasciocutaneous flap

Oral mucosa graft

31
Q

What is the success rate of penile fasciocutaneous grafts?

A

94%

32
Q

What is the success rate of oral mucosal grafts?

A

83-100%

33
Q

What is the recommended treatment option for penile urethral strictures?

A

Urethroplasty

34
Q

A patient has a bulbar urethral stricture >2cm. What is the preferred treatment?

A

Urethroplasty

35
Q

A patient has Bulbar urethral stricture >4cm. How do the success rates between endoscopic tx and urethroplasty compare for these types of strictures?

A

Endoscopic: 20%
Urethroplasty: >80%

36
Q

What is the first choice graft harvest site for urethroplasty?

A

The inner cheek

37
Q

What is the problem with performing a single stage tubularized graft?

A

High rate of restenosis

38
Q

What are the tx options for bladder neck contracture after endoscopic prostate procedure or vesicourethral anastomoses?

A

Dilation
bladder neck incision
TURBN

39
Q

What is the success rate for first time tx of vesicourethral anastomotic strictures?

A

50-80%

40
Q

What are the treatment options for patients on CIC for neurogenic bladder who develop a stricture?

A

Urethroplasty

Suprapubic tube

41
Q

What should be done if lichen sclerosis is suspected?

A

Biopsy

42
Q

What is the rate of squamous cell carcinoma in patients with lichen sclerosis?

A

2-8.6%

43
Q

How should lichen sclerosis be treated?

A

Clobetasol

mometasone

44
Q

What should be avoided when treating lichen sclerosis?

A

Avoid genital skin flaps

45
Q

What should be done to evaluate the urethra in fracture urethral injuries?

A

retrograde urethrography, voiding cystourethrography (VCUG) and/or retrograde urethroscopy

46
Q

A patient has a pelvic fracture urethral injury. What treatment is recommended

A

Delayed urethroplasty

47
Q

What are the methods of gaining urethral length during an anastomotic urethroplasty?

A
  1. Mobilize the bulbar urethra
  2. Crural separation
  3. Inferior pubectomy and supracrural rerouting
  4. Transabdominal, transpubic.
48
Q

What is the standard amount of time to wait after a pelvic fracture urethral injury before urethroplasty?

A

3-6 months.

AUA guidelines (7 decks)

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