Urethral stricture disease, once associated mainly with gonococcal urethritis, is now most frequently a consequence of trauma, such as a fall-astride injury or a pelvic fracture. This article discusses issues and approaches related to the treatment of strictures associated with perineal straddle trauma and pelvic fracture urethral distraction defects. The authors emphasize that endoscopic procedures seldom cure these strictures and in-dwelling stents are seldom useful in treatment. Primary anastomotic techniques are associated with success rates in the high 90% range and appear to be remarkably durable in most cases. In contrast, tubed reconstruction of the urethra is inevitably associated with diminished success rates and with problems of durability.
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