A clinical framework to guide providers in the diagnosis and treatment of male urethral stricture has been developed by authors on behalf of American Urological Association Education and Research, Inc. The report was published in the Journal of Urology.
The evidence-based guidelines should be used to recognize symptoms and signs of a urethral stricture, carry out appropriate testing to determine the location and severity of the stricture, and recommend the best options for treatment and follow-up, the authors wrote. Using Pubmed, Embase, and Cochrane databases, the researchers identified 250 peer-reviewed articles on the diagnosis and treatment of urethral stricture published between January 1, 1990, and December 1, 2015. The group assessed the benefits, risks, and burdens to patients to identify the recommendations as strong, moderate, or conditional.
The authors indicated that, in developed countries, the most common etiology of urethral stricture, defined as any abnormal narrowing of the anterior and posterior urethra, is idiopathic, followed by iatrogenic (eg, late failure of hypospadias surgery and endoscopic manipulation). In developing countries, trauma is the most common cause.
For diagnosis, the authors recommended (moderate) that clinicians should include urethral stricture in the differential diagnosis of men who present with decreased urinary stream, incomplete emptying, dysuria, urinary tract infection, and rising post-void residual (PVR). Following history, physical examination, and urinalysis, clinicians may use a combination of patient-reported measures, uroflowmetry, and ultrasound PVR assessment in the initial evaluation of suspected urethral stricture, the authors wrote. To make a diagnosis of urethral stricture, the authors recommended urethrocystoscopy, retrograde urethrography, voiding cystourethrography, or ultrasound urethrography (moderate recommendation). Ultrasound urethrography may serve to diagnose the presence, as well as describe the location, length, and severity of narrowing, of urethral strictures, they added.
The guidelines also include recommendations for interventions and management of urethral stricture, which are mainly surgical. In postoperative follow-up, the authors recommended that clinicians monitor patients to identify symptomatic recurrence following dilation, direct visual internal urethrotomy, or urethroplasty. Erectile dysfunction may occur after urethroplasty, but symptoms tend to resolve within six months of the procedure.
- Wessells H, Angermeier KW, Elliott S, et al. Male urethral stricture: American Urological Association guideline. J Urol. January 2017. doi: 10.1016/j.juro.2016.07.087.