Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks

This is a review article on treatment of bulbar urethral strictures with personal critical remarks on newer developments. As a treatment of first intention there exists 4 options : dilatation, urethrotomy, end to end anastomosis and free graft, open urethroplasty. Success rate of dilatation and vis...

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Main Author: Willem Oosterlinck
Format: Article
Language:English
Published: Wiley 2003-01-01
Series:The Scientific World Journal
Online Access:http://dx.doi.org/10.1100/tsw.2003.34
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author Willem Oosterlinck
author_facet Willem Oosterlinck
author_sort Willem Oosterlinck
collection DOAJ
description This is a review article on treatment of bulbar urethral strictures with personal critical remarks on newer developments. As a treatment of first intention there exists 4 options : dilatation, urethrotomy, end to end anastomosis and free graft, open urethroplasty. Success rate of dilatation and visual urethrotomy after 4 years is only 20 en 40 % respectively. Laser urethrotomy could not fulfill expectations. End to end anastomosis obtains a very high success rate but is only applicable for short strictures. Free graft urethroplasty obtains success rates of ± 80 %. There is considerable debate on the best material for grafting. Buccal mucosa graft is the new wave, but this is not based on scientific data. Whether this graft should be used dorsally or ventrally is also a point of discussion. In view of the good results published with both techniques it is probably of no importance. Intraluminal stents are not indicated for complicated cases and give only good results in those cases which can easily be treated with other techniques. Metal self-retaining urethral stent , resorbable stents and endoscopic urethroplasty is briefly discussed. Redo’s and complicated urethral strictures need often other solutions. Here skin flap from the penile skin and scrotal flap can be used. Advantages and drawbracks of both are discussed. There is still a place for two-stage procedures in complicated redo�s. The two-stage mesh-graft urethroplasty offers advantage over the use of scrotal skin. Some other rare techniques like substitution with bowel and pudendal thigh flap, to cover deep defects, are also discussed.
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spelling doaj-art-683bf735934d44ebac438e643f9662432025-02-03T05:53:02ZengWileyThe Scientific World Journal1537-744X2003-01-01344345410.1100/tsw.2003.34Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical RemarksWillem Oosterlinck0Department of Urology, University Hospital, Ghent, BelgiumThis is a review article on treatment of bulbar urethral strictures with personal critical remarks on newer developments. As a treatment of first intention there exists 4 options : dilatation, urethrotomy, end to end anastomosis and free graft, open urethroplasty. Success rate of dilatation and visual urethrotomy after 4 years is only 20 en 40 % respectively. Laser urethrotomy could not fulfill expectations. End to end anastomosis obtains a very high success rate but is only applicable for short strictures. Free graft urethroplasty obtains success rates of ± 80 %. There is considerable debate on the best material for grafting. Buccal mucosa graft is the new wave, but this is not based on scientific data. Whether this graft should be used dorsally or ventrally is also a point of discussion. In view of the good results published with both techniques it is probably of no importance. Intraluminal stents are not indicated for complicated cases and give only good results in those cases which can easily be treated with other techniques. Metal self-retaining urethral stent , resorbable stents and endoscopic urethroplasty is briefly discussed. Redo’s and complicated urethral strictures need often other solutions. Here skin flap from the penile skin and scrotal flap can be used. Advantages and drawbracks of both are discussed. There is still a place for two-stage procedures in complicated redo�s. The two-stage mesh-graft urethroplasty offers advantage over the use of scrotal skin. Some other rare techniques like substitution with bowel and pudendal thigh flap, to cover deep defects, are also discussed.http://dx.doi.org/10.1100/tsw.2003.34
spellingShingle Willem Oosterlinck
Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks
The Scientific World Journal
title Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks
title_full Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks
title_fullStr Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks
title_full_unstemmed Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks
title_short Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks
title_sort treatment of bulbar urethral strictures a review with personal critical remarks
url http://dx.doi.org/10.1100/tsw.2003.34
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