Trauma is more usually iatrogenic and attributable to

Trauma is more usually iatrogenic and attributable to instrumentation these days but also includes the more dramatic fall astride injuries to the bulbar urethra and pelvic fracture related injuries to the membranous urethra and bulbo‐membranous junction.

Figure 13. Penetrating urethral injury from a gunshot wound. Retrograde urethrogram demonstrates contrast material extravasation from the penile urethra.

Stricture following traumatic bulbomembranous urethral distraction injury.

Urethral injury in penile fracture. Retrograde urethrogram reveals contrast material extravasation in the penile urethra adjacent to the site of a corpus cavernosal injury.

Treatment of urethral stricture diseases includes numerous reconstructive surgical techniques. The urologist must be familiar with all of these different techniques to be able to deal with any type of urethral stricture. The choice of reconstructive technique depends on the: Site of stricture Stricture length degree of spongiofibrosis surgeon preference experience.

It is now generally accepted that urethrotomy and dilatation are equally effective and can be expected to cure about 50% of short bulbar urethral strictures when first used. If the procedure has to be repeated, it is rarely curative and it is rarely curative even the first time in strictures other than in the bulbar urethra.

Anastomotic urethroplasty is generally only applicable in two situations. Firstly, for short strictures of the bulbar urethra, no more than 1– 2 cm long, which are generally attributable to external trauma or are otherwise idiopathic in origin (possibly congenital). The external trauma is usually a fall astride injury. The second situation is a pelvic fracture related injury of the membranous urethra or bulbo‐membranous junction.

Substitution urethroplasty should not therefore be used universally; it should be used selectively for those strictures of the bulbar urethra that are too long for an anastomnotic repair and all strictures of the penile urethra in which an anastomotic repair would cause unacceptable penile deformity on erection.

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