Anterior Urethra Stricture(Penile And Bulbar)
Bulbar urethra is the most common site of urethral stricture. Bulbar urethra stricture occurs because of trauma (straddle injury), instrumentation, infection and lichen sclerosis. Bulbar urethra is susceptible to the injury because of absence of protection. During injury the bulbar urethra is crushed against bone. In some cases, there is immediately swelling and blood at the urethal meatus. However in most cases, the bulbar stricture subsequently develops slowly over time as the injury heals with a scar which gradually contracts. Traumatic strictures are short segment dense strictures.
(Bulbar stricture can be categorized according to stricture length and density of stricture spongiofibrosis).
- If stricture is less than or 1 cm treatment options are:
- Internal urethrotomy is a good option if stricture is short and not very dense (spongiofibrosis). In short segment and mucosal strictures success rate is around 70%.
- End to end anastomotic urethroplasty is a good option (especially with dense spongifibrosis and near complete obliteration) with success rate over 90%.
- Buccal mucosa urethroplasty is a viable option as is take care of proximal and distal grey area of urethra (potential area for restricture formation)
- If stricture is between 1 to 2 cm options are :
- Internal urethrotomy is an option but it has got poor success rate (≤ 30-40%) over period of 2 years.
- End to end anastomotic urethroplasty is an option if stricture is mid or proximal bulbar. (Length can be achieved after urethral mobilization).
- Buccal mucosa augmented urethroplasty is the treatment of choice for these kind of strictures with very good success rate.
- Long segment anterior urethra stricture:
- Buccal mucosa urethroplasty( mucosa harvested from cheek) is the treatment of choice
- If urethra is densely scarred with complete obliteration of lumen of if urethral abscess is present along with urethritis treatment option can be two staged urethroplasty.
End to end anastomotic repair for short segment and dense stricture and buccal mucosa augmented urethroplasty for short and long stricture are the best treatment we offer to our patients.