Management of penile urethral strictures: Challenges and future directions

Figure 1 Typical appearance of lichen sclerosus with scarring on the glans, loss of the normal contour of the glans and coronal sulcus, meatal regression and stenosis.

Figure 2 Urethral stricture after failed mid-penile hypospadias reconstruction.

Figure 3 Operative image showing a complete first stage full-length penile urethroplasty using bilateral buccal mucosal grafts quilted dorsally to create a neo-urethral plate of adequate calibre to be retubularised in the second stage.

Figure 4 Operative image showing (A) harvesting of a sublingual graft and (B) bilateral sublingual graft donor sites closed primarily.

Figure 5 Operative image showing a preputial skin free graft being harvested.

Figure 6 Kulkarni technique for long penile strictures via a transperineal approach with (A) invagination of the penis and (B) dorsolateral placement of the sublingual graft.

Figure 7 “Two-in-one” stage approach for a distal penile urethral stricture using oral mucosal graft. A: Ventral stricturotomy; B: Glans cleft deepened; C: Spongiofibrosis excised; D: Neo-urethral plate created using oral mucosa; E and F: Retubularised in layers in one stage.

Figure 8 Ascending urethrogram showing a short penile urethral stricture limited to the fossa navicularis.

Figure 9 Entire penile and distal bulbar urethra affected by a Lichen Sclerosus-related stricture.

Figure 10 Multiple urethrocutaneous fistulae after failed hypospadias repair.