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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Mar 24, 2016; 5(1): 1-10
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.1
Management of penile urethral strictures: Challenges and future directions
Felix Campos-Juanatey, Simon Bugeja, Stella L Ivaz, Anastasia Frost, Daniela E Andrich, Anthony R Mundy
Felix Campos-Juanatey, Simon Bugeja, Stella L Ivaz, Anastasia Frost, Daniela E Andrich, Anthony R Mundy, Institute of Urology, University College London Hospitals, London NW1 2PG, United Kingdom
Felix Campos-Juanatey, Marques de Valdecilla University Hospital, Santander39008, Spain
Author contributions: Campos-Juanatey F and Bugeja S reviewed the literature and drafted the manuscript; Ivaz SL and Frost A contributed to review the literature; Andrich DE and Mundy AR review the manuscript and made critical revision and edition of the contents; all authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors declare no potential conflicts of interest related with the contents of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anthony R Mundy, PhD, MS, FRCS, FRACS, Professor, Medical Director, Institute of Urology, University College London Hospitals, ULCH Trust Headquarters, 2nd floor central, 250 Euston Road, London NW1 2PG, United Kingdom. kelly.higgs@uclh.nhs.uk
Telephone: +44-20-34479099 Fax: +44-20-34479401
Received: September 21, 2015
Peer-review started: September 22, 2015
First decision: November 24, 2015
Revised: December 15, 2015
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: March 24, 2016
Processing time: 179 Days and 13.9 Hours
Abstract

The anatomy of the penile urethra presents additional challenges when compared to other urethral segments during open stricture surgery particularly because of its unsuitability for excision and primary anastomosis and its relatively deficient corpus spongiosum. Stricture aetiology, location, length and previous surgical intervention remain the primary factors influencing the choice of penile urethroplasty technique. We have identified what we feel are the most important challenges and controversies in penile urethral stricture reconstruction, namely the use of flaps vs grafts, use of skin or oral mucosal tissue for augmentation/substitution and when a single or a staged approach is indicated to give the best possible outcome. The management of more complex cases such as pan-urethral lichen-sclerosus strictures and hypospadias “cripples” is outlined and potential developments for the future are presented.

Keywords: Reconstructive surgical procedures; Anterior urethral stricture; Oral mucosa; Tissue transplants; Skin grafting; Hypospadias; Lichen sclerosus

Core tip: The anatomy of the penile urethra presents additional challenges when compared to other urethral segments. Stricture aetiology, location, length and previous surgical intervention remain the primary factors influencing the choice of penile urethroplasty technique. We described the most important challenges and controversies in penile urethral stricture reconstruction: Use of flaps vs grafts, use of skin or oral mucosal tissue for augmentation/substitution and when a single or a staged approach is indicated to give the best possible outcome. The management of more complex cases (pan-urethral lichen-sclerosus strictures and hypospadias “cripples”) is outlined and potential developments for the future are presented.