Abstract/Text: INTRODUCTION: the management of anterior urethral stricture is controversial. A review article was written, which updates the current situation of the surgical treatment of anterior urethral stricture.
MATERIALS AND METHODS: the experience of the Hospital del Trabajador in Santiago de Chile regarding its different surgical approaches, as well as scientific literature on the topic, were reviewed.
RESULTS: traditionally, anterior urethral stricture has been treated using minimally invasive techniques (dilatation and internal urethrotomy), which are unable to cure more than 30-35% of patients. On the other hand, urethral reconstruction surgery (urethroplasty) is more complex and requires training, however it can cure a wide majority of patients in a single surgical procedure. Due to a lack of experience and training in reconstructive surgery, non-invasive methods are overused and abused, to the detriment of the patients' quality of life. There is substantial evidence that internal urethrotomy is an excellent method for treating stricture of up to 1cm in length, however its efficacy decreases drastically above 1.5cm. Notwithstanding, urethroplasty is directly indicated for larger strictures, especially if prior urethrotomy failed.
CONCLUSION: this procedure must be managed selectively, applying the appropriate treatment aimed at curing and not only palliating the disease. Urologists must be better trained in urethroplasty and/or centres of excellence must be established to be able to offer the best treatment in each case.

Copyright © 2010 AEU. Published by Elsevier Espana. All rights reserved.

Abstract/Text: CONTEXT: Reconstructive surgeons who perform urethroplasty have a variety of techniques in their armamentarium that may be used according to factors such as aetiology, stricture position, and length. No one technique is recommended.
OBJECTIVE: Our aim was to assess the reported outcomes of the various techniques for graft augmentation urethroplasty according to site of surgery.
EVIDENCE ACQUISITION: We performed an updated systematic review of the Medline literature from 1985 to date and classified the data according to the site of surgery and technique used. Data are also presented on the type of graft used and the follow-up methodology used by each centre.
EVIDENCE SYNTHESIS: More than 2000 anterior urethroplasty procedures have been described in the literature. When considering the bulbar urethra there is no significant difference between the average success rates of the dorsal and the ventral onlay procedures, 88.4% and 88.8% at 42.2 and 34.4 mo in 934 and 563 patients, respectively. The lateral onlay technique has only been described in six patients and has a reported success rate of 83% at 77 mo. The Asopa and Palminteri techniques have been described in 89 and 53 patients with a success rate of 86.7% and 90.1% at 28.9 and 21.9 mo, respectively. When considering penile strictures, the success rate of the two-stage penile technique is significantly better than the one-stage penile technique, 90.5% versus 75.7% as calculated for 129 and 432 patients, respectively, although the follow-up of one-stage procedures was longer at 32.8 mo compared with 22.2 mo.
CONCLUSIONS: There is no evidence in the literature of a difference between one-stage techniques for urethroplasty of the bulbar urethra. The two-stage technique has better reported outcomes than a one-stage approach for penile urethroplasty but has a shorter follow-up.

Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Abstract/Text: INTRODUCTION: the management of anterior urethral stricture is controversial. A review article was written, which updates the current situation of the surgical treatment of anterior urethral stricture.
MATERIALS AND METHODS: the experience of the Hospital del Trabajador in Santiago de Chile regarding its different surgical approaches, as well as scientific literature on the topic, were reviewed.
RESULTS: traditionally, anterior urethral stricture has been treated using minimally invasive techniques (dilatation and internal urethrotomy), which are unable to cure more than 30-35% of patients. On the other hand, urethral reconstruction surgery (urethroplasty) is more complex and requires training, however it can cure a wide majority of patients in a single surgical procedure. Due to a lack of experience and training in reconstructive surgery, non-invasive methods are overused and abused, to the detriment of the patients' quality of life. There is substantial evidence that internal urethrotomy is an excellent method for treating stricture of up to 1cm in length, however its efficacy decreases drastically above 1.5cm. Notwithstanding, urethroplasty is directly indicated for larger strictures, especially if prior urethrotomy failed.
CONCLUSION: this procedure must be managed selectively, applying the appropriate treatment aimed at curing and not only palliating the disease. Urologists must be better trained in urethroplasty and/or centres of excellence must be established to be able to offer the best treatment in each case.

Copyright © 2010 AEU. Published by Elsevier Espana. All rights reserved.