Urethral strictures - General aspects: Definition, anatomy of the urethra and its clinical application in stenosis, epidemiology, etiology, and principles of urethral reconstruction. | LitMetric
Department of Urology, La Conception Academic Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France.
Published: November 2024
AI Article Synopsis
Article Abstract
Background: Urethral strictures are a common and persistent pathology in urology with significant clinical repercussions. Our aim is to provide an overview of the general aspects of this condition.
Methods: A comprehensive review of the literature from PubMed was conducted covering the period from 2020 to 2023. This was complemented by a synthesis of the latest guidelines from the American, European, and French Urological Associations (AUA, EAU, AFU), as well as references from textbooks.
Results: Urethral stricture is defined by a narrowing of less than 16 French. The urethra is divided into posterior and anterior parts. The prevalence of urethral stricture is approximately 0.9%. The most common location for strictures is the anterior urethra, particularly its bulbar portion in males. The main causes are idiopathic, iatrogenic, traumatic, inflammatory, and infectious. A better understanding of urethral anatomy and histopathology provides a key element. Urethral reconstruction is based on prior urethral rest, detailed analysis of the stricture characteristics, and the use of grafts and flaps.
Conclusion: Urethral strictures remain a broad pathology. Their definition and epidemiology have been clarified. They require a thorough understanding of the anatomy, etiologies, and principles of urethral reconstruction to optimize management.
Objective: Urinary continence after radical prostatectomy is a crucial aspect of patient quality of life. The aim of this study was to identify the factors influencing urinary continence after robot-assisted laparoscopic radical prostatectomy, focusing on the role of anterior reconstruction.
Methods: We collected clinical data from 375 patients at a single institution.
Objective: To engineer an acellular mesh to reconstruct the urethra to replace the current surgical practice of using autologous tissue grafts. Cell based approaches have shown progress. However, these have been associated with high costs and logistical challenges.
Introduction: Although failures are undesirable, they offer valuable learning opportunities that drive progress through necessary changes. This concept holds particularly true in the history of urethral reconstruction.
Methods: A comprehensive literature review was conducted using PubMed, focusing on the history of the urethral stricture and current trends based on national and international guidelines for urethral stricture management.
Objective: The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, bladder mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material) (1, 2).
Traumatic perineal injuries are rare but can result in significant morbidity, particularly when the anal sphincter is injured. The management of such injuries in the pediatric population is rarely noted in the literature. We aimed to describe reconstruction in such patients using lessons learned in reoperative anorectal malformation surgery.
