Avoiding Unnecessary Urethroplasty by Periurethral Mobilization as a Treatment Option for Small Urethral Strictures: A Case Series

TL;DR

This case series shows that some small urethral strictures can be treated without surgery by using less invasive techniques like adhesiolysis and catheterization.

Contribution

Demonstrates that periurethral mobilization can avoid unnecessary urethroplasty in select patients with small urethral strictures.

Findings

Four patients with small urethral strictures avoided urethroplasty through adhesiolysis and catheterization.

Postoperative urinary flow rates and residual volumes improved significantly after the less invasive treatment.

Intraoperative re-evaluation helped identify patients suitable for non-surgical management.

Abstract

Urethral stricture remains a frequently encountered urological condition, with urethroplasty often regarded as the standard approach for complex or recurrent cases. However, in specific scenarios, intraoperative assessment may reveal less severe pathology, allowing for a more conservative and less invasive management strategy. This case series describes male patients who were scheduled for urethroplasty but were ultimately treated successfully with periurethral mobilization, adhesiolysis, and catheterization alone. Four male patients, aged between 19 and 51 years (mean age 31 years), presented with lower urinary tract symptoms, including weak urinary stream, straining, incomplete emptying, and acute urinary retention. Preoperative imaging with retrograde urethrogram and micturating cystourethrogram suggested bulbar urethral strictures with stricture length ranging from 0.5 to 2cm (mean 1.5 cm), and all patients were planned for urethroplasty. Initial maximum urinary flow rates (Qmax) ranged from 2 to 6 mL/second, with a mean of 3.75 mL/second, while post-void residual (PVR) urine volumes ranged from 200 to 320 mL, with a mean of 237.5 mL.

Intraoperatively, after mobilizing the urethra, dense periurethral adhesions were observed without significant intraluminal narrowing. Gentle insertion of a 16 Fr Foley catheter was successful in each case, leading to the decision to avoid urethroplasty. All patients were managed with adhesiolysis and catheter drainage. Postoperative follow-up demonstrated marked improvement in symptoms, with Qmax ranging from 24 to 27 mL/second, with a mean of 25.25 mL/second, and PVR volumes decreasing to 10 to 15 mL, with a mean of 12.75 mL. This series highlights the importance of intraoperative re-evaluation in patients with suspected urethral stricture. Careful mobilization and catheter testing can help identify those who can be effectively managed without urethroplasty, thereby minimizing surgical morbidity. Incorporating and reinforcing this step into operative planning can support more individualized and less invasive treatment strategies.

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