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Treatment of urethral stricture disease in men

Andrew Peterson, MD
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD


Urethral stricture disease is relatively common in men, with most patients acquiring the disease due to injury or infection. The most common etiology for stricture is iatrogenic injury due to urologic instrumentation (eg, oversized resectoscope at the time of transurethral surgery) or the placement of indwelling catheters [1]. These and other causes of urethral stricture are given in the table (table 1).

Although some patients are able to relate a definitive history of prior instrumentation, injury or infection, the etiology of the stricture often remains unknown due to the lag time between an inciting event and the development of symptoms. Most patients present with chronic voiding symptoms, but acute urinary obstruction can occur without significant warning, requiring emergent urethral dilation or urinary diversion. While most patients present with decreased force of urinary stream, some present with other symptoms such as recurrent infections, urinary spraying, dysuria, and sexual dysfunction such as decreased force of the ejaculate during orgasm.

Pretreatment evaluation identifies the location, length and severity of the stricture and guides the choice of treatment which can include minimally invasive therapies, urinary diversion, or urethral reconstruction. A single treatment strategy is not appropriate for all the different types of strictures.

The treatment of urethral stricture disease in men will be reviewed here. The discussion in this topic is in agreement with the 2016 American Urological Association guidelines on male urethral stricture [2]. The clinical features and diagnosis of the various pathologies that may result in urethral stricture are discussed in separate topic reviews.


The urethra conveys urine from the bladder to the exterior of the body. It is important to understand the urethral anatomy in the male because urethral stricture disease differs in its etiology, diagnosis and management based upon stricture location. Iatrogenic injury may affect any segment of the urethra. Pelvic fractures can cause distraction defects in the posterior urethra, whereas blunt perineal trauma injures the bulbar urethra. (See 'Urethroplasty technique by location' below.)


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Literature review current through: Jan 2017. | This topic last updated: Tue Jan 24 00:00:00 GMT+00:00 2017.
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  1. Lumen N, Hoebeke P, Willemsen P, et al. Etiology of urethral stricture disease in the 21st century. J Urol 2009; 182:983.
  2. Wessells H, Angermeier KW, Elliott S, et al. Male Urethral Stricture: American Urological Association Guideline. J Urol 2017; 197:182.
  3. Nuss GR, Granieri MA, Zhao LC, et al. Presenting symptoms of anterior urethral stricture disease: a disease specific, patient reported questionnaire to measure outcomes. J Urol 2012; 187:559.
  4. Bullock TL, Brandes SB. Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol 2007; 177:685.
  5. Barbagli G, Palminteri E, Lazzeri M, et al. Long-term outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol 2001; 165:1918.
  6. Barbagli G, Palminteri E, Guazzoni G, et al. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol 2005; 174:955.
  7. Morey AF, Lin HC, DeRosa CA, Griffith BC. Fossa navicularis reconstruction: impact of stricture length on outcomes and assessment of extended meatotomy (first stage Johanson) maneuver. J Urol 2007; 177:184.
  8. Steenkamp JW, Heyns CF, de Kock ML. Outpatient treatment for male urethral strictures--dilatation versus internal urethrotomy. S Afr J Surg 1997; 35:125.
  9. Morey AF, McAninch JW. Sonographic staging of anterior urethral strictures. J Urol 2000; 163:1070.
  10. Ather MH, Zehri AA, Soomro K, Nazir I. The safety and efficacy of optical urethrotomy using a spongiosum block with sedation: a comparative nonrandomized study. J Urol 2009; 181:2134.
  11. Munks DG, Alli MO, Goad EH. Optical urethrotomy under local anaesthesia is a feasible option in urethral stricture disease. Trop Doct 2010; 40:31.
  12. Stone AR, Randall JR, Shorrock K, et al. Optical urethrotomy--a 3-year experience. Br J Urol 1983; 55:701.
  13. Zhang K, Qi E, Zhang Y, et al. Efficacy and safety of local steroids for urethra strictures: a systematic review and meta-analysis. J Endourol 2014; 28:962.
  14. Badlani GH, Press SM, Defalco A, et al. Urolume endourethral prosthesis for the treatment of urethral stricture disease: long-term results of the North American Multicenter UroLume Trial. Urology 1995; 45:846.
  15. Parikh AM, Milroy EJ. Precautions and complications in the use of the urolume wallstent. Eur Urol 1995; 27:1.
  16. Wilson TS, Lemack GE, Dmochowski RR. UroLume stents: lessons learned. J Urol 2002; 167:2477.
  17. Hussain M, Greenwell TJ, Shah J, Mundy A. Long-term results of a self-expanding wallstent in the treatment of urethral stricture. BJU Int 2004; 94:1037.
  18. Chapple CR, Bhargava S. Management of the failure of a permanently implanted urethral stent-a therapeutic challenge. Eur Urol 2008; 54:665.
  19. Elliott DS, Boone TB. Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. J Urol 2001; 165:413.
  20. Albers P, Fichtner J, Brühl P, Müller SC. Long-term results of internal urethrotomy. J Urol 1996; 156:1611.
  21. Pansadoro V, Emiliozzi P. Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol 1996; 156:73.
  22. Steenkamp JW, Heyns CF, de Kock ML. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol 1997; 157:98.
  23. Rourke KF, Jordan GH. Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture. J Urol 2005; 173:1206.
  24. Anger JT, Buckley JC, Santucci RA, et al. Trends in stricture management among male Medicare beneficiaries: underuse of urethroplasty? Urology 2011; 77:481.
  25. Morey A. Urethral stricture is now an open surgical disease. J Urol 2009; 181:953.
  26. Heyns CF, Steenkamp JW, De Kock ML, Whitaker P. Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol 1998; 160:356.
  27. Wright JL, Wessells H, Nathens AB, Hollingworth W. What is the most cost-effective treatment for 1 to 2-cm bulbar urethral strictures: societal approach using decision analysis. Urology 2006; 67:889.
  28. Greenwell TJ, Castle C, Andrich DE, et al. Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. J Urol 2004; 172:275.
  29. Wessells H. Cost-effective approach to short bulbar urethral strictures supports single internal urethrotomy before urethroplasty. J Urol 2009; 181:954.
  30. Roehrborn CG, McConnell JD. Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. J Urol 1994; 151:869.
  31. Singh BP, Andankar MG, Swain SK, et al. Impact of prior urethral manipulation on outcome of anastomotic urethroplasty for post-traumatic urethral stricture. Urology 2010; 75:179.
  32. Breyer BN, McAninch JW, Whitson JM, et al. Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol 2010; 183:613.
  33. Barbagli G, De Angelis M, Romano G, Lazzeri M. Clinical outcome and quality of life assessment in patients treated with perineal urethrostomy for anterior urethral stricture disease. J Urol 2009; 182:548.
  34. Wessells H, McAninch JW. Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction. World J Urol 1998; 16:175.
  35. Andrich DE, Leach CJ, Mundy AR. The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int 2001; 88:385.
  36. Dubey D, Vijjan V, Kapoor R, et al. Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial. J Urol 2007; 178:2466.
  37. Barbagli G, Vallasciani S, Romano G, et al. Morbidity of oral mucosa graft harvesting from a single cheek. Eur Urol 2010; 58:33.
  38. Sinha RJ, Singh V, Sankhwar SN, Dalela D. Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption. BMC Urol 2009; 9:15.
  39. Mundy AR. The long-term results of skin inlay urethroplasty. Br J Urol 1995; 75:59.
  40. Monfort G, Bretheau D, Di Benedetto V, Bankole R. Urethral stricture in children: treatment by urethroplasty with bladder mucosa graft. J Urol 1992; 148:1504.
  41. Barbagli G, Selli C, di Cello V, Mottola A. A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. Br J Urol 1996; 78:929.
  42. Wang K, Miao X, Wang L, Li H. Dorsal onlay versus ventral onlay urethroplasty for anterior urethral stricture: a meta-analysis. Urol Int 2009; 83:342.
  43. Iselin CE, Webster GD. Dorsal onlay graft urethroplasty for repair of bulbar urethral stricture. J Urol 1999; 161:815.
  44. Elliott SP, Metro MJ, McAninch JW. Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 2003; 169:1754.
  45. Kane CJ, Tarman GJ, Summerton DJ, et al. Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction. J Urol 2002; 167:1314.
  46. Wessells H. Ventral onlay graft techniques for urethroplasty. Urol Clin North Am 2002; 29:381.
  47. McAninch JW. Reconstruction of extensive urethral strictures: circular fasciocutaneous penile flap. J Urol 1993; 149:488.
  48. Mundy AR, Stephenson TP. Pedicled preputial patch urethroplasty. Br J Urol 1988; 61:48.
  49. Orandi A. One-stage urethroplasty. Br J Urol 1968; 40:717.
  50. Orandi A. One-stage urethroplasty: 4-year followup. J Urol 1972; 107:977.
  51. Quartey JK. One-stage penile/preputial cutaneous island flap urethroplasty for urethral stricture: a preliminary report. J Urol 1983; 129:284.
  52. Reid RE. Turner-Warwick urethroplasty and urethral stricture. Results in 60 patients. Urology 1975; 6:711.
  53. Zinman L, Libertino JA. Turner-Warwick urethroplasty for membranous urethral stricture. Revised technique. Urology 1973; 2:265.
  54. Pisapati VL, Paturi S, Bethu S, et al. Dorsal buccal mucosal graft urethroplasty for anterior urethral stricture by Asopa technique. Eur Urol 2009; 56:201.
  55. Schulte-Baukloh H, Stürzebecher B, Blömers F, et al. Orandi one-stage urethroplasty using the subcutaneous pedicle graft modification of Raatzsch--long-term results. Scand J Urol Nephrol 2004; 38:321.
  56. Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol 2001; 165:1496.
  57. Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol 2002; 167:1715.
  58. Morey AF, Kizer WS. Proximal bulbar urethroplasty via extended anastomotic approach--what are the limits? J Urol 2006; 175:2145.
  59. Feng C, Xu YM, Barbagli G, et al. The relationship between erectile dysfunction and open urethroplasty: a systematic review and meta-analysis. J Sex Med 2013; 10:2060.
  60. Haines T, Rourke KF. The effect of urethral transection on erectile function after anterior urethroplasty. World J Urol 2016.
  61. Glass RE, Flynn JT, King JB, Blandy JP. Urethral injury and fractured pelvis. Br J Urol 1978; 50:578.
  62. Elliott DS, Barrett DM. Long-term followup and evaluation of primary realignment of posterior urethral disruptions. J Urol 1997; 157:814.
  63. Webster GD, Sihelnik S. The management of strictures of the membranous urethra. J Urol 1985; 134:469.
  64. Flynn BJ, Delvecchio FC, Webster GD. Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years. J Urol 2003; 170:1877.
  65. Webster GD, Ramon J, Kreder KJ. Salvage posterior urethroplasty after failed initial repair of pelvic fracture membranous urethral defects. J Urol 1990; 144:1370.
  66. Bertrand LA, Voelzke BB, Elliott SP, et al. Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures. J Urol 2016; 196:453.
  67. Lumen N, Hoebeke P, Oosterlinck W. Urethroplasty for urethral strictures: quality assessment of an in-home algorithm. Int J Urol 2010; 17:167.
  68. Andrich DE, Dunglison N, Greenwell TJ, Mundy AR. The long-term results of urethroplasty. J Urol 2003; 170:90.
  69. Blaschko SD, McAninch JW, Myers JB, et al. Repeat urethroplasty after failed urethral reconstruction: outcome analysis of 130 patients. J Urol 2012; 188:2260.
  70. Barbagli G, Guazzoni G, Lazzeri M. One-stage bulbar urethroplasty: retrospective analysis of the results in 375 patients. Eur Urol 2008; 53:828.
  71. DeLong J, Buckley J. Patient-reported outcomes combined with objective data to evaluate outcomes after urethral reconstruction. Urology 2013; 81:432.
  72. Dogra PN, Saini AK, Seth A. Erectile dysfunction after anterior urethroplasty: a prospective analysis of incidence and probability of recovery--single-center experience. Urology 2011; 78:78.
  73. Koraitim MM. The lessons of 145 posttraumatic posterior urethral strictures treated in 17 years. J Urol 1995; 153:63.
  74. Iselin CE, Webster GD. The significance of the open bladder neck associated with pelvic fracture urethral distraction defects. J Urol 1999; 162:347.
  75. Lewis JB, Wolgast KA, Ward JA, Morey AF. Outpatient anterior urethroplasty: outcome analysis and patient selection criteria. J Urol 2002; 168:1024.
  76. Granieri MA, Webster GD, Peterson AC. A Critical Evaluation of the Utility of Imaging After Urethroplasty for Bulbar Urethral Stricture Disease. Urology 2016; 91:203.