Urethral reconstructive surgery, or urethroplasty, is the only “definitive” treatment option for urethral strictures. It is usually reserved for strictures that are severe or non-responsive to endoscopic management
There are 2 general types of urethroplasty procedures:
- Primary anastamotic repairs: Primary anastamotic repairs involve excision of the stricture with reconnection of the healthy ends of urethra in a widened configuration.
- Substitution repairs: Substitution urethroplasty involves tissue transfer techniques typically using buccal mucosa (inner cheek lining) grafts or genital skin flaps to build on to the stricture and increase its caliber
Surgery for urethral strictures, or urethroplasty, is varied and involves many different techniques. If strictures are short and in certain portions of the urethra, the area of the urethra can be surgically removed and the healthy urethra can be reconnected. If the urethral stricture is lengthy, then other tissues need to be used to reconstruct the urethra.
One common tissue used in surgery for longer strictures is the lining of the inner cheek; this is referred to as buccal mucosa. Buccal mucosa has a tissue characteristic very similar to the native lining of the urethra and the mouth heals very well after harvest of this graft. Other options that are used for lengthy strictures include a piece of the penile skin. This is referred to as a penile circular fasciocutaneous flap and can be used on strictures that stretch throughout the penis.
Screening and Diagnostic Tests
Before undergoing the procedure, the patient may need to undergo the following investigations:
- Post-void residual volume.
- Retrograde urethrogram.
- Urine exam.
- Urinary flow rate.
- Urine culture.