Current indications and technique of two-stage repair for membranous urethral strictures

At present, the indications for two-stage repair for membranous urethral strictures are limited. However, there are situations where two-stage reconstruction is the procedure of choice. It certainly should be considered in those patients who present with marked scarring in the perineum from previous attempts at urethral reconstruction or from the initial trauma, such as might be encountered following perineal burns or gunshot wounds. It is also successful in those patients in whom the anterior urethra has previously been damaged and cannot be mobilized or is not healthy enough to permit a tension-free end-to-end anastomosis and in patients who have perineal abscesses, infected fistulae, or infected urethral diverticula with or without calculi. The technique selected in these complicated cases must ensure adequate drainage of infected material as well as provide an excellent blood supply for the graft.