Urethra strictures: What surgery for which stricture?

Urethral stricture is a complex disease, of varied etiology, and as old as the controversy regarding its treatment.

Described and used for thousands of years, dilatations and urethrotomies are still the most used treatments in the world despite being non-curative.

To cure urethral strictures, it is necessary to remove the pathological fibrous tissue and provide healthy tissue. This means to replace the damaged urethral wall. To achieve this, innumerable tissue transfer alternatives have been tried, using practically all existing tissues and elements.

The anatomical substrate of the stricture, Spongiofibrosis, consists of scar tissue in the urethral spongy body. It is characterised by loss of elasticity and decreased vascularization secondary to collagen deposits below the mucosa. It may vary in length and depth which will condition the surgical technique of choice.

There is no single technique to correct all types of strictures and there are several factors that influence the choice of the most appropriate technique which are namely:

•Location

•Cause

•Length

•Multiplicity

•Local adverse factors

The following presentation will explain the different techniques that can be used depending on the location, length and local characteristics of the stricture.