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Decision Making

The most important point before treating stricture urethra with open surgery, dilatation or internal urethrotomy is to take informed consent. Patient should be properly informed about the disease, its prognosis or expected outcome and all reasonable treatment options with their risks and benefits.

Unfortunately most of the strictures are poorly managed because routine urologists have limited knowledge and exposure to various treatment modalities. It is very common for patients to be treated with dilatation or a urethrotomy or multiple dilatation or urethrotomies without being informed of the option of urethral reconstruction. Most of the patients are not investigated properly and imaging studies are lacking.

When imaging studies are not performed, stricture length and density of scar is not defined properly leading to use of wrong modality of treatment. This leads to recurrence of stricture and symptoms. Therefore, if the stricture happens to be long and dense, the patient is being treated with a procedure very likely to fail without knowing that open reconstruction is the current standard of care and the option that best offers the possibility of a cure.

The modern approach to urethral stricture disease requires a full evaluation with urethral imaging, and a treatment decision that is based on the location and length of stricture. A dilatation or urethrotomy is an option, especially when the stricture is short, located in bulbar segment of urethra and without significant scarring of the surrounding or when the goal is to obtain some improvement, temporary or least invasive. In most cases these procecures (Dilatation and internal urethrotomy) are not good options. This is especially true when strictures are recurrent as the failure rate approaches 100 % in such cases. Moreover the trauma of dilatation and urethrotomy can lead to progression of the disease.

A properly performed open urethral reconstruction may be the best option for initial management in many cases and is usually the best option for the treatment of recurrent strictures.

Modern surgical techniques performed by specialist in urethral reconstruction using dedicated instruments and equipments are associated with high cure rates and a low complicate rate. However, the treatment should be based on the findings obtained during a diagnostic evaluation, and a detailed discussion of all options with treatment tailored to individual patient.

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