AUA: Male Urethral Stricture (2016): Difference between revisions

Line 117:

==== Approach ====

*'''Initial treatment based on location of stricture'''

*'''Initial treatment based on location of stricture'''

** '''Fossa navicularis'''

*** '''Initial treatment of uncomplicated urethral stricture confined to the meatus or fossa navicularis: simple dilation or meatotomy,''' with or without guidewire placement

*** '''Initial treatment of uncomplicated urethral stricture confined to the meatus or fossa navicularis: simple dilation or meatotomy,''' with or without guidewire placement

*** '''Associated with previous hypospadias repair, prior failed endoscopic manipulation, previous urethroplasty, or LS: urethroplasty'''

*** '''Associated with previous hypospadias repair, prior failed endoscopic manipulation, previous urethroplasty, or LS: urethroplasty'''

**** Meatal and fossa navicularis strictures refractory to endoscopic procedures are unlikely to respond to further endoscopic treatments. Furthermore, urethroplasty is the best option for completely obliterated strictures or strictures associated with previous hypospadias repair or LS.

** '''Penile urethra'''

*** '''Initial treatment: urethroplasty'''

*** '''Initial treatment: urethroplasty'''

**** '''High recurrence rates are expected with endoscopic treatments.'''

*** '''Penile urethral strictures are more likely to require tissue transfer and/or a staged approach''' '''compared to bulbar urethral strictures'''

** '''Bulbar urethra'''

*** '''Initial treatment of stricture < 2cm: endoscopic management or urethroplasty'''

*** '''Initial treatment of stricture < 2cm: endoscopic management or urethroplasty'''

**** '''Dilation and DVIU have similar success and complication rates and can be used interchangeably'''.

***** Few studies exist that compare different methods of performing DVIU, but cold knife and laser incision of the stricture scar appear to have similar success rates and may be used interchangeably.

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***** '''Repeated endoscopic treatment may cause longer strictures, and may increase the complexity of subsequent urethroplasty.'''

***** In patients who are unable to undergo, or who prefer to avoid, urethroplasty, repeated endoscopic procedures, or intermittent self-catheterization may be considered as palliative measures.

*** '''Initial treatment of stricture ≥2cm: urethroplasty'''

*** '''Initial treatment of stricture ≥2cm: urethroplasty'''

**** Longer strictures are less responsive to endoscopic treatment

* Long multi-segment strictures (panurethral) may be reconstructed with one stage or multi-stage techniques using oral mucosal grafts, penile fasciocutaneous flaps or a combination of these techniques.

@@ Line 117: / Line 117: @@
 ==== Approach ====
-*'''Initial treatment based on location of stricture'''
+*'''<span style="color:#ff0000">Initial treatment based on location of stricture</span>'''
 ** '''Fossa navicularis'''
-*** '''Initial treatment of uncomplicated urethral stricture confined to the meatus or fossa navicularis: simple dilation or meatotomy,''' with or without guidewire placement
+*** '''<span style="color:#ff0000">Initial treatment of uncomplicated urethral stricture confined to the meatus or fossa navicularis: simple dilation or meatotomy,</span>''' with or without guidewire placement
-*** '''Associated with previous hypospadias repair, prior failed endoscopic manipulation, previous urethroplasty, or LS: urethroplasty'''
+*** '''<span style="color:#ff0000">Associated with previous hypospadias repair, prior failed endoscopic manipulation, previous urethroplasty, or LS: urethroplasty'''
 **** Meatal and fossa navicularis strictures refractory to endoscopic procedures are unlikely to respond to further endoscopic treatments. Furthermore, urethroplasty is the best option for completely obliterated strictures or strictures associated with previous hypospadias repair or LS.
 ** '''Penile urethra'''
-*** '''Initial treatment: urethroplasty'''
+*** '''<span style="color:#ff0000">Initial treatment: urethroplasty</span>'''
 **** '''High recurrence rates are expected with endoscopic treatments.'''
 *** '''Penile urethral strictures are more likely to require tissue transfer and/or a staged approach''' '''compared to bulbar urethral strictures'''
 ** '''Bulbar urethra'''
-*** '''Initial treatment of stricture < 2cm: endoscopic management or urethroplasty'''
+*** '''<span style="color:#ff0000">Initial treatment of stricture < 2cm: endoscopic management or urethroplasty</span>'''
 **** '''Dilation and DVIU have similar success and complication rates and can be used interchangeably'''.
 ***** Few studies exist that compare different methods of performing DVIU, but cold knife and laser incision of the stricture scar appear to have similar success rates and may be used interchangeably.
@@ Line 134: / Line 134: @@
 ***** '''Repeated endoscopic treatment may cause longer strictures, and may increase the complexity of subsequent urethroplasty.'''
 ***** In patients who are unable to undergo, or who prefer to avoid, urethroplasty, repeated endoscopic procedures, or intermittent self-catheterization may be considered as palliative measures.
-*** '''Initial treatment of stricture ≥2cm: urethroplasty'''
+*** '''<span style="color:#ff0000">Initial treatment of stricture ≥2cm: urethroplasty</span>'''
 **** Longer strictures are less responsive to endoscopic treatment
 * Long multi-segment strictures (panurethral) may be reconstructed with one stage or multi-stage techniques using oral mucosal grafts, penile fasciocutaneous flaps or a combination of these techniques.