Urethral Strictures in Males Guidelines

Updated: Dec 30, 2018
  • Author: Joshua A Broghammer, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines

Guidelines Summary

In 2016, the American Urology Association (AUA) released guidelines for the diagnosis and treatment of male urethral strictures. Key recommendations for diagnosis include [33] :

  • Urethral stricture should be considered in the differential diagnosis of patients who present with decreased urinary stream, incomplete emptying, dysuria, urinary tract infection (UTI), and after rising post void residual. 
  • Clinicians should use urethro-cystoscopy, retrograde urethrography, voiding cystourethrography, or ultrasound urethrography to make a diagnosis of urethral stricture. 
  • Perform biopsy for suspected lichen sclerosus (LS), or if urethral cancer is suspected. 

Treatment

Recommendations for treatment with dilation, internal urethrotomy, and urethroplasty include [33] :

  • Offer urethral dilation, direct visual internal urethrotomy (DVIU), or urethroplasty for the initial treatment of a short (< 2 cm) bulbar urethral stricture. 
  • Either dilation or DVIU may be performed when endoscopic treatment is utilized. 
  • The urethral catheter can be safely removed within 72 hours following uncomplicated dilation or DVIU. 
  • Self-catheterization after DVIU to maintain urethral patency for patients who are not candidates for urethroplasty. 
  • Offer urethroplasty, instead of repeated endoscopic management, for recurrent anterior urethral strictures following failed dilation or DVIU. 
  • Monitor urethral stricture patients to identify symptomatic recurrence following dilation, DVIU or urethroplasty. 

Major recommendations for anterior urethral reconstruction are as follows [33] :

  • Initially treat meatal or fossa navicularis strictures with either dilation or meatotomy. 
  • Offer urethroplasty to patients with recurrent meatal or fossa navicularis strictures. 
  • Urethroplasty for patients with penile urethral strictures, given the expected high recurrence rates with endoscopic treatments. 
  • Initially treat patients with long (≥2 cm) bulbar urethral strictures with urethroplasty 
  • Reconstruct long multi-segment strictures with one stage or multi-stage techniques using oral mucosal grafts, penile fasciocutaneous flaps or a combination of these techniques.
  • Offer perineal urethrostomy as a long-term treatment option to patients as an alternative to urethroplasty.
  • Oral mucosa is preferred when using grafts for urethroplasty. 

For patients with pelvic fracture urethral injury, UAU guidelines recommendations include [33] :

  • Use retrograde urethrography with voiding cystourethrogram and/or retrograde + antegrade cystoscopy for preoperative planning of delayed urethroplasty after pelvic fracture urethral injury (PFUI). 
  • Perform delayed urethroplasty instead of delayed endoscopic procedures after urethral obstruction/obliteration due to PFUI. 
  • Definitive urethral reconstruction for PFUI should be planned only after major injuries stabilize and patients can be safely positioned for urethroplasty.