Management of urethral strictures and their outcome

Urethral stricture is a challenging surgical problem since the ancient time. Its outcome is very poor because of the high recurrence rate 40.0-50.0% whatever procedure is conducted to treat the condition. Between January 2004 to December 2007, 61 cases with urethral stricture were treated in our hospital. Management of stricture was decided according to the grading of urethral stricture. Of 61 cases, 42 (68.8%) had grade I-II, 10 (16.4%) had grade III and 9 (14.8%) had grade IV strictures. They were treated with optical internal urethrotomy (OIU), modified railroading and end to end anastomotic urethroplasty respective to gradings. During the average 2 years follow up period, outcome of strictures were analyzed. Recurrence of stricture was noted 31.0% in grade I-II after OIU and 11.0% in grade IV after urethroplasty. However, in cases with grade III stricture recurrence rate was observed in 60.0% after modified railroading. During the follow up period, 50.0% of the grade III strictures were converted to urethroplasty. It is suggested that, OIU is still a gold standard procedure to manage the lower grade (I-II) strictures with low morbidity, minimally invasive and success rate is 69.0%. End to end anastomotic urethroplasty for grade IV stricture has very good result (89.0%) but needs skilful mobilization of distal urethra to prevent chordee. However, grade III stricture needs open urethroplasty or modified railroading by using flexible cystoscopy which may reduce recurrence rate.