Background: Male anterior urethral stricture disease is a
challenging condition characterised by fibrotic narrowing of the urethra, most
often in the bulbar or penile segments. It leads to obstructive voiding
symptoms and significantly impacts quality of life. Definitive management
requires surgical urethral reconstruction (urethroplasty), which offers far
superior long-term success compared to repeated dilations or urethrotomies This
chapter reviews the etiology, classification, and anatomy of anterior urethral
strictures, and provides an in-depth discussion of urethral reconstruction
techniques, including excision and primary anastomosis (EPA), substitution
urethroplasty with buccal mucosa graft (BMG), penile skin flap urethroplasty,
staged repairs, and perineal urethrostomy.
Methods: A comprehensive analysis of contemporary and
classical literature was performed, incorporating landmark contributions (e.g.
Barbagli, Kulkarni, Mundy) and recent series. Outcomes, indications, and
complications of each reconstructive technique are summarised, and a
comparative table is provided for quick reference.
Results: Short bulbar strictures (<2 cm) are effectively
cured by EPA with success rates >90%. Longer or multiple strictures are
managed with substitution urethroplasty using buccal mucosal grafts, which is
now the standard augmentation tissue and yields durable success in ~85–95% of
cases, depending on stricture length and location. Penile fasciocutaneous flap
techniques (e.g. Orandi, circular flaps) can achieve comparable success to
grafts in appropriately selected patients, though flap use has declined due to
higher donor site morbidity (torsion, sacculation, etc.). Complex and lengthy
strictures (particularly those due to lichen sclerosus) often require two-stage
repairs to achieve a stable urethral calibre. Perineal urethrostomy is reserved
as a salvage or permanent solution in refractory cases and offers excellent
relief of obstruction with an acceptable quality of life.
Conclusions: Male anterior urethral strictures can be
effectively reconstructed with a variety of techniques tailored to stricture characteristics.
In experienced hands at high-volume centres, one-stage urethroplasty
(anastomotic or substitution) achieves long-term cure in the majority of
patients, with overall success rates exceeding 85–90%.
Buccal mucosa has become the graft of choice for
augmentation. Proper patient selection and preoperative optimisation are
crucial. Postoperatively, patients require structured follow-up with objective
(uroflowmetry, ultrasound imaging) and subjective (symptom scores) assessments
to detect and manage recurrences early. This chapter provides urologists with a
detailed, evidence-based guide to contemporary urethral reconstruction,
including technical pearls, expected outcomes, and management of complications.
Author(s) Details
Velmurugan
Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research Chennai India.
Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research Chennai India.
Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research Chennai India.
Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research Chennai India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH8
