Urethral Stricture

Question 1

What is the lining of the posterior urethra?

Answer 1

Transitional epithelium

Question 2

What is the lining of the anterior urethra?

Answer 2

pseudostratified squamous epithelium

Question 3

What is the lining of the fossa navicularis?

Answer 3

stratified squamous epithelium

Question 4

What is narrowing of the posterior urethra called?

Answer 4

stenosis

Question 5

What is narrowing of the anterior urethra called?

Answer 5

stricture

Question 6

What are the two leading causes of urethral strictures in developed countries?

Answer 6

Idiopathic 41%

Iatrogenic 35%

Question 7

What is the leading cause of urethral stricture in developing countries?

Answer 7

Trauma 36%

Question 8

What are the common presenting symptoms of patients with urethral strictures?

Answer 8

Decreased urine stream
Incomplete emptying 
UTI
Epididymitis
Decreased ejaculation

Question 9

What should be included in the workup of a patient with slow stream?

Answer 9

Thorough history
Physical exam
UA
Urine culture
PVR
Uroflow/UDS
Cystoscopy
RUG

Question 10

What is the duration of foley catheter placement following surgery for urethral structure?

Answer 10

Typically 2-3 weeks after which a RUG or VCUG is obtained.

Question 11

What are the possible sexual side effects of urethroplasty?

Answer 11

Ejaculatory dysfunction 21%

Erectile dysfunction 1%

Question 12

What is the uroflow rate associated with urethral strictures?

Answer 12

Less than 12ml/s

Question 13

What is recommended to confirm the diagnosis of a urethral stricture?

Answer 13

Urethroscopy
RUG
VCUG
US urethography

Question 14

What is the diagnostic of choice for confirmation of urethral stricture?

Answer 14

RUG

Question 15

What information is required before planning treatment for a stricture?

Answer 15

Length and location of the stricture.

Question 16

What are the treatment options when a patient is in urinary retention and has a urethral stricture?

Answer 16

Suprapubic cystostomy
Urethral dilation
DVIU

Question 17

What should be done before definitive management for a urethral stricture if urethroplasty is being considered?

Answer 17

4-12 weeks of urethral rest with suprapubic tube if necessary to allow full stricture to declare itself.

Question 18

What are the treatment options and success rates for bulbar urethral strictures < 2cm?

Answer 18

Dilation (35-70%)
DVIU (35-70%)
Urethroplasty (80-95%)

Question 19

How does DVIU compare to dilation when endoscopic management is desired?

Answer 19

Dilation and DVIU may be used interchangeably

Question 20

What is the data regarding injection of steroids or mitomycin C at time of stricture treatment?

Answer 20

There is weak evidence to suggest that it decreases recurrence rate but stronger studies with long term follow up are needed.

Question 21

When can catheters be removed safely following DVIU or dilation?

Answer 21

24-72 hours

Question 22

What is the next step in a patient who just underwent a redo DVIU but is not a candidate for a urethroplasty?

Answer 22

They should be started on self catheterization as stricture recurrence rates were significantly lower among patients performing self-catheterization (risk ratio 0.51, 95% CI 0.32 to 0.81, p = 0.004

Question 23

What is the next step in most patients who failed at least one endoscopic procedure for urethral stricture?

Answer 23

Urethroplasty

Question 24

What is the failure rate for repeat endoscopic management of urethral strictures?

Answer 24

> 80%

Question 25

What are the initial options for treatment of meatal or fossa navicularis strictures?

Answer 25

Dilation | Meatotomy

Question 26

What factors may complicate tx of fossa navicularis/meatal strictures?

Answer 26

Hypospadias repair Failed endoscopy Urethroplasty Lichen sclerosis

Question 27

What initial tx can be used for meatal strictures due to LS?

Answer 27

extended meatotomy in conjunction with high-dose topical steroids

Question 28

What should be done with the patient that has recurrent meatal or fossa navicularis strictures?

Answer 28

Surgeons should offer urethroplasty.

Question 29

What is the success rate of uncomplicated meatotomy?

Answer 29

87%

Question 30

What is the most common method of repair for the fossa navicularis?

Answer 30

Penile fasciocutaneous flap Oral mucosa graft

Question 31

What is the success rate of penile fasciocutaneous grafts?

Answer 31

94%

Question 32

What is the success rate of oral mucosal grafts?

Answer 32

83-100%

Question 33

What is the recommended treatment option for penile urethral strictures?

Answer 33

Urethroplasty

Question 34

A patient has a bulbar urethral stricture >2cm. What is the preferred treatment?

Answer 34

Urethroplasty

Question 35

A patient has Bulbar urethral stricture >4cm. How do the success rates between endoscopic tx and urethroplasty compare for these types of strictures?

Answer 35

Endoscopic: 20% Urethroplasty: >80%

Question 36

What is the first choice graft harvest site for urethroplasty?

Answer 36

The inner cheek

Question 37

What is the problem with performing a single stage tubularized graft?

Answer 37

High rate of restenosis

Question 38

What are the tx options for bladder neck contracture after endoscopic prostate procedure or vesicourethral anastomoses?

Answer 38

Dilation bladder neck incision TURBN

Question 39

What is the success rate for first time tx of vesicourethral anastomotic strictures?

Answer 39

50-80%

Question 40

What are the treatment options for patients on CIC for neurogenic bladder who develop a stricture?

Answer 40

Urethroplasty | Suprapubic tube

Question 41

What should be done if lichen sclerosis is suspected?

Answer 41

Biopsy

Question 42

What is the rate of squamous cell carcinoma in patients with lichen sclerosis?

Answer 42

2-8.6%

Question 43

How should lichen sclerosis be treated?

Answer 43

Clobetasol | mometasone

Question 44

What should be avoided when treating lichen sclerosis?

Answer 44

Avoid genital skin flaps

Question 45

What should be done to evaluate the urethra in fracture urethral injuries?

Answer 45

retrograde urethrography, voiding cystourethrography (VCUG) and/or retrograde urethroscopy

Question 46

A patient has a pelvic fracture urethral injury. What treatment is recommended

Answer 46

Delayed urethroplasty

Question 47

What are the methods of gaining urethral length during an anastomotic urethroplasty?

Answer 47

1. Mobilize the bulbar urethra 2. Crural separation 3. Inferior pubectomy and supracrural rerouting 4. Transabdominal, transpubic.

Question 48

What is the standard amount of time to wait after a pelvic fracture urethral injury before urethroplasty?

Answer 48

3-6 months.