What are the recommended management options for a patient diagnosed with a urethral stricture?

Management of a patient diagnosed with a urethral stricture involves a stepwise approach tailored to the severity, location, and length of the stricture, as well as patient factors. Initial assessment should include specialist evaluation with history, physical examination, and investigations such as uroflowmetry, post-void residual measurement, and cystoscopy if indicated to confirm diagnosis and assess stricture characteristics NICE CG97.

Conservative management may be considered for mild, asymptomatic strictures or in patients unfit for surgery, involving intermittent self-catheterisation to maintain urethral patency and prevent retention NICE CG97.

Surgical options are the mainstay for symptomatic or complicated strictures. These include urethral dilation and direct visual internal urethrotomy (DVIU), which may be offered initially but have higher recurrence rates NICE CG97. Definitive treatment often requires urethroplasty, which provides better long-term outcomes and can be tailored to stricture location and length, using techniques such as excision and primary anastomosis or substitution grafts (e.g., buccal mucosa graft) Sohngen et al. 2020.

In cases of complex or recurrent strictures, referral to a specialist urologist experienced in reconstructive surgery is recommended NICE CG97. For patients with strictures following prostate cancer treatment, management may be more challenging and individualized, sometimes requiring bladder neck reconstruction or urinary diversion Browne & Vanni 2017.

Long-term follow-up is important to monitor for recurrence and complications. Emerging literature highlights challenges in management in resource-limited settings and the need for individualized treatment plans based on available expertise and patient preferences Payne et al. 2022.