Editing Urethral stricture (section)

== Treatment ==
Initial treatment usually involves urethral dilation (widening the tube) or [[urethrotomy]], where the stricture is cut away with a [[Cystoscopy|cystoscope]].

=== Dilation and urethrotomy ===

Urethral dilation and other [[Endoscopy|endoscopic]] approaches such as [[urethrotomy|direct vision internal urethrotomy (DVIU)]], laser urethrotomy, and self intermittent dilation are the most commonly used treatments for urethral stricture. However, these approaches are associated with low success rates<ref>Santucci R and Eisenberg L: Urethrotomy has a much lower success rate than previously reported. J Urol 2010; 183: 1859.</ref> and may worsen the stricture, making future attempts to surgically repair the urethra more difficult.<ref>{{cite journal | url=https://www.auajournals.org/doi/10.1016/j.juro.2011.12.074 | doi=10.1016/j.juro.2011.12.074 | title=Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated with Increased Stricture Complexity and Prolonged Disease Duration | journal=Journal of Urology | date=May 2012 | volume=187 | issue=5 | pages=1691–1695 | last1=Hudak | first1=Steven J. | last2=Atkinson | first2=Timothy H. | last3=Morey | first3=Allen F. | pmid=22425115 | url-access=subscription }}</ref>

A Cochrane review found that performing intermittent self-dilatation may confer a reduced risk of recurrent urethral stricture after endoscopic treatment, but the [[Scientific evidence|evidence]] is weak.<ref>{{cite journal|last1=Jackson|first1=MJ|last2=Veeratterapillay |first2=R |last3=Harding |first3=CK|last4=Dorkin|first4=TJ|title=Intermittent self-dilatation for urethral stricture disease in males.|journal=The Cochrane Database of Systematic Reviews|date=19 December 2014|volume=2014|issue=12|pages=CD010258|pmid=25523166|doi=10.1002/14651858.CD010258.pub2|pmc=10880810}}</ref>

=== Urethroplasty ===

[[Urethroplasty]] refers to any open reconstruction of the urethra. Success rates range from 85% to 95% and depend on a variety of clinical factors, such as stricture as the cause, length, location, and caliber.<ref name="S">Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol. 2002 Apr;167(4):1715-9.</ref><ref name="F">Figler BD, Malaeb BS, Dy GW, Voelzke BB, [[Hunter Wessells|Wessells H.]] Impact of graft position on failure of single-stage bulbar urethroplasties with buccal mucosa graft. Urology. 2013 Nov;82(5):1166-70.</ref><ref name="Barbagli">Barbagli G1, Sansalone S, Romano G, Lazzeri M. Bulbar urethroplasty: transecting vs. nontransecting techniques. Curr Opin Urol. 2012 Nov;22(6):474-7.</ref><ref name="Bello">Bello JO. Impact of preoperative patient characteristics on posturethroplasty recurrence: the significance of stricture length and prior treatments. Niger J Surg. 2016; 22(2):86-89</ref> Urethroplasty can be performed safely on men of all ages.<ref>Santucci RA, McAninch JW, Mario LA et al. (July 2004). "Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications". J Urol. 172 (1): 201–3.</ref>

In the [[posterior urethra]], anastomotic urethroplasty (with or without preservation of bulbar arteries) is typically performed after removing scar tissue.{{citation needed|date=April 2021}}

In the [[bulbar urethra]],<ref name="S" /><ref name="F" /><ref name="Barbagli" /> the most common types of urethroplasty are anastomotic (with or without preservation of corpus spongiosum and bulbar arteries) and substitution with [[buccal mucosa graft]], full-thickness [[skin graft]], or split thickness skin graft. These are nearly always done in a single setting (or stage).{{citation needed|date=April 2021}}

In the [[penile urethra]], anastomotic urethroplasties are rare because they can lead to chordee (penile curvature due to a shortened urethra). Instead, most penile urethroplasties are substitution procedures utilizing buccal mucosa graft, full-thickness skin graft, or split-thickness skin graft. These can be done in one or more settings, depending on stricture location, severity, cause and patient or surgeon preference.

=== Urethral stent ===
[[File:3D Medical Animation Urethral Stunt.jpg|alt=3D Medical Animation still shot of Urethral Stent|thumb|254x254px|3D medical animation still shot of urethral stent]]
A permanent urethral stent<ref>{{cite web|url=http://www.americanmedicalsystems.com/prof_male_detail_objectname_prof_urolume_ureth_stricture.html|archive-url=https://web.archive.org/web/20060313034647/http://www.americanmedicalsystems.com/prof_male_detail_objectname_prof_urolume_ureth_stricture.html|url-status=dead|archive-date=13 March 2006|title=Urolume Endoprosthesis|website=americanmedicalsystems.com|access-date=21 April 2018}}</ref> was approved for use in men with bulbar urethral strictures in 1996, but was recently{{When|date=July 2021}} removed from the market.{{Citation needed|date=July 2021}}

A temporary thermoexpandable urethral stent (Memotherm) is available in Europe but is not currently approved for use in the United States.

=== Emergency treatment ===

When in acute urinary retention, treatment of the urethral stricture or diversion is an emergency. Options include:
* Urethral dilatation and catheter placement. This can be performed in the [[Emergency Department]], a practitioner's office or an operating room. The advantage of this approach is that the urethra may remain patent for a period of time after the dilation, though long-term success rates are low.
* Insertion of a [[suprapubic catheter]] with catheter drainage system.  This procedure is performed in an Operating Room, Emergency Department or practitioner's office. The advantage of this approach is that it does not disrupt the scar and interfere with future definitive surgery.

=== Ongoing care ===

Following urethroplasty, patients should be monitored for a minimum of 1 year, since the vast majority of recurrences occur within 1 year.

Because of the high rate of recurrence following dilation and other endoscopic approaches, the provider must maintain a high index of suspicion for recurrence when the patient presents with obstructive voiding symptoms or urinary tract infection.