Management of Panurethral Stricture Disease in India

• Published in: The Journal of urology Vol. 188; no. 3; pp. 824 - 830
• Main Authors: Kulkarni, Sanjay Balwant, Joshi, Pankaj M, Venkatesan, Krishnan
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2012; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Feasibility Studies; Humans; India; Male; Medical sciences; Middle Aged; mouth mucosa; Mouth Mucosa - transplantation; Nephrology. Urinary tract diseases; Retrospective Studies; transplants; urethra; urethral stricture; Urethral Stricture - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures, Male; Urology; Asia; India; oral mucosa graft; Qmax; LS; urethral stricture; OMG; mouth mucosa; urethra; lichen sclerosus; maximum urine flow velocity; transplants; India; Nephrology; Urinary system disease; Urethral disease; Disease; Mucosa; Urinary tract disease; Urology; Clinical management; Urethra; Urethral stenosis
• ISSN: 0022-5347; 1527-3792; 1527-3792
• DOI: 10.1016/j.juro.2012.05.020

Purpose Panurethral stricture involving the penile and bulbar urethra is a common urological problem on the South Asian subcontinent. It represents a particularly difficult challenge to manage and there is a relative paucity of literature on the subject. In India lichen sclerosus is the most common etiology of panurethral stricture, followed by iatrogenic causes. We present our experience with panurethral stricture repair using 1-stage, 1-side dissection dorsal onlay repair with oral mucosa grafts. Materials and Methods We retrospectively reviewed the records of 117 consecutive men who underwent treatment for panurethral stricture from June 1998 to December 2010. Median patient age was 47.8 years, mean stricture length was 14 cm and median followup was 59 months. The stricture was approached through a perineal incision, limiting dissection to only 1 side of the urethra. The penis was invaginated to provide access to the entire length of anterior urethra in 1 stage. Two oral mucosal grafts were placed dorsally. Results The outcome was considered a success if the patient required no further instrumentation, including dilation or urethrotomy. The overall success rate was 83.7% with a success rate of 86.5% for primary urethroplasty and 61.5% in patients in whom urethroplasty had previously failed. Most recurrent strictures developed at the proximal end of the graft. Conclusions Repair of panurethral stricture in 1 stage with 1-side dissection and dorsal onlay of oral mucosa graft is a minimally invasive technique that is simple, fast, safe, effective and reproducible by any surgeon.