Treatment of strictures of the male anterior urethra: Bulbar urethra.

BACKGROUND

Bulbar urethral strictures are the most frequently encountered. Their management is standardized and needs to be applied to improve results.

METHODS

A comprehensive literature review was conducted from December 2020 to December 2023, combined with a summary of recommendations from the American, Canadian, European, and French urological associations. References from these recommendations were also used.

RESULTS

Endoscopic treatment is only associated with good results in the case of initial treatment of a short stricture (<2cm). Repeat treatment is not recommended. In all other cases, urethroplasty should be performed. The main techniques, including excision and primary anastomosis (EPA), augmentation and stage urethroplasty, are detailed in this chapter. EPA with or without transection is associated with over 90% success rate for short stenoses. Penile and sexual complications are more frequent with transection of the corpus spongiosum. Augmentation urethroplasty is associated with a similar success rate. The impact of augmentation position on patency has not yet been demonstrated. In the most complicated cases, a stage urethroplasty is required, with a success rate of 33.3-94.6%. Perineal urethrostomy is still a valid option in refractory cases.

CONCLUSION

This review should provide a better understanding of the different surgical treatments available, in order to propose the best management for each patient.