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Urethral stricture

What's new

Added 2023 AUA, 2023 EAU, and 2020 CUA guidelines for the diagnosis and management of urethral strictures.


Key sources

The following summarized guidelines for the evaluation and management of urethral stricture are prepared by our editorial team based on guidelines from the American Urological Association (AUA 2023,2014), the European Association of Urology (EAU 2023), the Canadian Urological Association (CUA 2020), and the World Society of Emergency Surgery (WSES/AAST 2019). ...
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Classification and risk stratification

Severity assessment
As per EAU 2023 guidelines:
Use a validated patient-reported outcome measure to assess symptom severity and impact on the QoL in patients undergoing surgery for urethral stricture.
Use a validated tool to assess sexual function in male patients undergoing surgery for urethral stricture.
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Diagnostic investigations

Initial evaluation
As per AUA 2023 guidelines:
Include urethral stricture in the differential diagnosis of patients presenting with a decreased urinary stream, incomplete emptying, dysuria, UTI, and rising post-void residual.
Consider using a combination of patient-reported measures, uroflowmetry, and ultrasound post-void residual assessment in the initial evaluation of suspected urethral stricture, following history, physical examination, and urinalysis.

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  • Diagnostic imaging

Medical management

Conservative management
As per EAU 2023 guidelines:
Do not perform an intervention in patients with asymptomatic incidental (> 16 Fr) urethral strictures.
Consider offering long-term suprapubic catheterization in patients with radiation-induced bulbomembranous strictures and/or poor performance status.

Therapeutic procedures

Intraurethral/intralesional injections
As per EAU 2023 guidelines:
Administer intraurethral corticosteroids, in addition to intralesional corticosteroids, to stabilize the urethral stricture.
Administer intralesional injections only in the context of a clinical trial.

Perioperative care

Preoperative urethral rest: as per AUA 2023 guidelines, consider placing a suprapubic cystostomy to promote "urethral rest" before definitive urethroplasty in patients dependent on an indwelling urethral catheter or intermittent self-dilation.

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  • Intraoperative antibiotic prophylaxis

  • Postoperative catheter removal

Surgical interventions

Timing for surgery: as per AUA 2023 guidelines, consider performing a urethral endoscopic intervention (such as urethral dilation or direct visual internal urethrotomy) or immediate suprapubic cystostomy for urgent management of urethral strictures, such as symptomatic urinary retention or need for catheterization before another surgical procedure.

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  • Endoluminal management (indications)

  • Endoluminal management (technical considerations)

  • Endoluminal management (postoperative care)

  • Urethroplasty (bulbar strictures)

  • Urethroplasty (meatal stenosis or fossa navicularis/penile strictures)

  • Urethroplasty (panurethral urethral reconstruction)

  • Urethroplasty (tissue grafts)

  • Perineal urethrostomy

  • Cystectomy and urinary diversion

Specific circumstances

Patients with traumatic urethral injury, monitoring: as per AUA 2014 guidelines, monitor patients for stricture formation for at least one year after urethral injury.

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  • Patients with traumatic urethral injury (evaluation)

  • Patients with traumatic urethral injury (management)

  • Patients with radiation-induced strictures

  • Patients with lichen sclerosus-related strictures

  • Patients with strictures after prostatic interventions

  • Patients with strictures after hypospadias repair

  • Patients requiring chronic self-catheterization

  • Female patients (evaluation)

  • Female patients (urethral dilation)

  • Female patients (urethroplasty)

  • Transgender patients

Patient education

General counseling: as per EAU 2023 guidelines, counsel about safe sexual practices, educate about symptoms of STIs, and provide access to prompt investigation and treatment in male patients with urethritis.

Follow-up and surveillance

Follow-up: as per AUA 2023 guidelines, obtain monitoring for symptomatic recurrence after urethral dilation, direct visual internal urethrotomy, or urethroplasty.

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  • Management of recurrent strictures

Quality improvement

Requirements for urinary catheterization: as per EAU 2023 guidelines, avoid performing unnecessary urethral catheterization.
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