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Kveten A.G.1,2, Nitkin D.M.1
Algorithm for choosing the method of surgical treatment for urethral strictures in males
1Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus
2Minsk Regional Clinical Hospital, Minsk district, Republic of Belarus

Vestnik VGMU. 2020;19(2):19-27.

This literature review provides information on existing approaches to the surgical treatment of urethral strictures in males. Data on the use of minimally invasive methods (dilation, balloon dilatation, stenting, internal optical urethrotomy, transurethral resection) and methods of urethroplasty (anastomotic, substitutional, meatotomy and meatoplasty, perineostomy) are presented, the short-term and long-term results of the application of these techniques are described.
High results of the application of endourological interventions, reaching 80% success rate, are described. However, there are conflicting opinions according to which the effectiveness of internal optical urethrotomy in the long term does not exceed 30%.
At the same time, with urethral strictures of more than 2 cm, open urethroplasty is often performed, the effectiveness of some methods of which surpasses the results of endourological interventions. On thе basis of the literature review done, based on current trends, a comprehensive algorithm has been developed for choosing the method for surgical treatment of urethral strictures in males, depending on the length, localization, etiology, anamnesis, concomitant diseases, and the patient’s age. In the future, this algorithm can help in choosing a method of surgical treatment, reduce the recurrence rate in the long term and lead to an improvement in the life quality of patients with urethral strictures.
Key words: urethral stricture, dilation, stenting, urethrotomy, urethroplasty.


1. Kogan MI. Urethral strictures in men: reconstructive surgery. Moscow: Prakt meditsina; 2010. 143 р. (In Russ.)
2. Jackson MJ, Veeratterapillay R, Harding CK, Dorkin TJ. Intermittent self-dilatation for urethral stricture disease in males. Cochrane Database Syst Rev. 2014 Dec 19;(12):CD010258. doi: 10.1002/14651858.CD010258.pub2
3. Ivaz SL, Veeratterapillay R, Jackson MJ, Harding CK, Dorkin TJ, Andrich DE, et al. Intermittent self-dilatation for urethral stricture disease in males: A systematic review and meta-analysis. Neurourol Urodyn. 2016 Sep;35(7):759-63. doi:
4. Chhabra JS, Balaji SS, Singh A, Mishra S, Ganpule AP, Sabnis RB, et al. Urethral Balloon Dilatation: Factors Affecting Outcomes. Urol Int. 2016;96(4):427-31. doi:
5. Gelman J, Liss MA, Cinman NM. Direct vision balloon dilation for the management of urethral strictures. J Endourol. 2011 Aug;25(8):1249-51. doi:
6. Ishii G, Naruoka T, Kasai K, Hata K, Omono H, Suzuki M, et al. High pressure balloon dilation for vesicourethral anastomotic strictures after radical prostatectomy. BMC Urol. 2015 Jul;15:62. doi:10.1186/s12894-015-0059-9
7. Atesci YZ, Karakose A, Aydogdu O. Long-term results of permanent memotherm urethral stent in the treatment of recurrent bulbar urethral strictures. Int Braz J Urol. 2014 Jan-Feb;40(1):80-6. doi:
8. Angulo JC, Kulkarni S, Pankaj J, Nikolavsky D, Suarez P, Belinky J, et al. Urethroplasty After Urethral Urolume Stent: An International Multicenter Experience. Urology. 2018 Aug;118:213-219. doi:10.1016/j.urology.2018.04.031
9. Zheng X, Han X, Cao D, Xu H, Yang L, Ai J, et al. Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials. World J Urol. 2019 Dec;37(12):2785-2793. doi:10.1007/s00345-019-02729-3
10. Pal DK, Kumar S, Ghosh B. Direct visual internal urethrotomy: Is it a durable treatment option? Urol Ann. 2017 Jan-Mar;9(1):18-22. doi:
11. Kranz J, Reiss PC, Salomon G, Steffens J, Fisch M, Rosenbaum CM. Differences in Recurrence Rate and De Novo Incontinence after Endoscopic Treatment of Vesicourethral Stenosis and Bladder Neck Stenosis. Front Surg. 2017 Aug;4:44. doi:10.3389/fsurg.2017.00044
12. Austoni E. Penis Reconstructive Surgery Atlas. Moscow, RF: ABV-press; 2012. 568 р. (In Russ.)
13. Godley SP, Sturm RM, Durbin-Johnson B, Kurzrock EA. Meatal stenosis: a retrospective analysis of over 4000 patients. J Pediatr Urol. 2015 Feb;11(1):38. doi:
14. Babu P, Nayak A, Javali TD, Joshi P, Nagaraj HK, Aggarwal K. Evaluation of Jordan's meatoplasty for the treatment of fossa navicularis strictures. A retrospective stud. Cent European J Urol. 2017;70(1):103-106. doi:10.5173/ceju.2017.916
15. Jordan G, Chapple C, Heyns C, ed. Urethral Strictures. An International Consultation on Urethral Strictures, Marrakech, Morocco, October 13-16, 2010. Shanghai, China; 2012. 285 p.
16. Barbagli G, De Angelis M, Romano G, Lazzeri M. Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol. 2007 Dec;178(6):2470-3. doi:
17. Culty T, Boccon-Gibod L. Anastomotic urethroplasty for posttraumatic urethral stricture: previous urethral manipulation has a negative impact on the final outcome. J Urol. 2007 Apr;177(4):1374-7. doi:
18. Bugeja S, Andrich DE, Mundy AR. Non-transecting bulbar urethroplasty. Transl Androl Urol. 2015 Feb;4(1):41-50. doi:
19. Kotov SV. Anastomotic urethroplasty without crossing the spongy body (surgical technique). Andrologiia Genital Khirurgiia. 2015;16(3):49-52. (In Russ.)
20. Kveten' AG, Nitkin DM. Modern aspects of the diagnosis and surgical treatment of urethral strictures in men. Meditsina. 2019;(1):51-5. (In Russ.)
21. Fu Q, Zhang Y, Zhang J, Xie H, Sa YL, Jin S. Substitution urethroplasty for anterior urethral stricture repair: comparison between lingual mucosa graft and pedicled skin flap. Scand J Urol. 2017 Dec;51(6):479-483. doi:
22. Falandry L. One stage surgical treatment of complex urethral strictures with a pedicled skin graft. Report of 104 cases. J Urol (Paris). 1990;96(6):315-21.
23. Venkatesan K, Blakely S, Nikolavsky D. Surgical Repair of Bulbar Urethral Strictures: Advantages of Ventral, Dorsal, and Lateral Approaches and When to Choose Them. Adv Urol. 2015;2015:397936. doi:
24. Pathak HR, Jain TP, Bhujbal SA, Meshram KR, Gadekar C, Parab S. Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty. Turk J Urol. 2017 Sep;43(3):350-354. doi:
25. Singh BP, Andankar MG, Swain SK, Das K, Dassi V, Kaswan HK, et al. Impact of prior urethral manipulation on outcome of anastomotic urethroplasty for post-traumatic urethral stricture. Urology. 2010 Jan;75(1):179-82. doi:
26. Rosenbaum CM, Dahlem R, Maurer V, Kluth LA, Vetterlein MW, Fisch M, et al. The T-plasty as therapy for recurrent bladder neck stenosis: success rate, functional outcome, and patient satisfaction. World J Urol. 2017 Dec;35(12):1907-1911. doi:10.1007/s00345-017-2089-2
27. Ram-Liebig G, Barbagli G, Heidenreich A, Fahlenkamp D, Romano G, Rebmann U6, et al. Results of Use of Tissue-Engineered Autologous Oral Mucosa Graft for Urethral Reconstruction: A Multicenter, Prospective, Observational Trial. EBioMedicine. 2017 Sep;23:185-192. doi:
28. Lopez JC, Gomez EG, Carrillo AA, Castineira RC, Tapia MJ. Perineostomy: the last opportunity. Int Braz J Urol. 2015 Jan-Feb;41(1):91-8. doi:
29. Murphy GP, Fergus KB, Gaither TW, Baradaran N, Voelzke BB, Myers JB, et al. Urinary and Sexual Function after Perineal Urethrostomy for Urethral Stricture Disease: An Analysis from the TURNS. J Urol. 2019 May;201(5):956-961. doi:10.1097/JU.0000000000000027
30. Bullock TL, Brandes SB. Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol. 2007 Feb;177(2):685-90.
31. Lyubchak AM, Lyubchak MA. Lichen sclerosing disease of the urethra. Zdorov'e Muzhchiny. 2016;(2):72-9. (In Russ.)
32. Guido B, Enzo P, Guazzoni G, Cavalcanti A. Bulbar urethroplasty using the dorsal approach: current techniques. Int Braz J Urol. 2003 Apr;29(2):155-61. doi:
33. Singh J. Surgical management of urethrals stricture: presentation on surgical methods for management of urethral strictures. Available from: [Accessed 02th Apr 2020].

Information about authors:
Kveten A.G. – postgraduate of the Chair of Urology & Nephrology, Belarusian Medical Academy of Post-Graduate Education; urologist, Minsk Regional Clinical Hospital;
Nitkin D.M. – Doctor of Medical Sciences, professor of the Chair of Urology & Nephrology, rector, Belarusian Medical Academy of Post-Graduate Education.

Correspondence address: Republic of Belarus, 220025, Minsk, 11А Esenina str., 33. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Alexander G. Kveten.

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