Urethroplasty is the surgical repair of an injury or defect within the walls of the

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

Trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

iatrogenic injury A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, ...

and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the

gold standard A gold standard is a monetary system in which the standard economic unit of account is based on a fixed quantity of gold. The gold standard was the basis for the international monetary system from the 1870s to the early 1920s, and from the la ...

treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group. There are four commonly used types of urethroplasty performed;

anastomotic An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal ...

, buccal

mucosal A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...

onlay graft, scrotal or penile island flap, and Johansen's urethroplasty. With an average

operating room Operation or Operations may refer to: Arts, entertainment and media * ''Operation'' (game), a battery-operated board game that challenges dexterity * Operation (music), a term used in musical set theory * ''Operations'' (magazine), Multi-Man ...

time of between three and eight hours, urethroplasty is not considered a minor operation. Patients who undergo a shorter duration procedure may have the convenience of returning home that same day (between 20% and 30% in total of urethroplasty patients). Hospital stays of two or three days duration are the average. More complex procedures may require a hospitalization of seven to ten days.

Phases of the operation

These parts of the operation are common to all specific operations.

Preoperative

Ideally, the patient will have undergone urethrography to visualize the positioning and length of the defect. The normal pre-surgical testing/screening (per the policies of the admitting hospital, anesthesiologist, and urological surgeon) will be performed, and the patient will be advised to ingest nothing by mouth, " NPO", for a predetermined period of time (usually 8 to 12 hours) prior to the appointed time. Upon arrival to the preoperative admitting area, the patient will be instructed to don a surgical gown and be placed into a receiving bed, where monitoring of

vital signs Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a ...

, initiation of a normal saline IV drip, and pre-surgical medication including IV

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

, and a

benzodiazepine Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...

class sedative, usually

diazepam Diazepam, first marketed as Valium, is a medicine of the benzodiazepine family that acts as an anxiolytic. It is commonly used to treat a range of conditions, including anxiety, seizures, alcohol withdrawal syndrome, muscle spasms, insomnia, a ...

midazolam Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia and procedural sedation, and to treat severe agitation. It works by inducing sleepiness, decreasing anxiety, and causing a loss of a ...

will be started/administered.

Operative

The patient will be transported to the operating room and the procedures for induction of the type of anesthesia chosen by both the patient and medical staff will be started. The subject area will be prepped by shaving, application of an antiseptic wash (usually

povidone iodine Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may ...

chlorhexidine gluconate Chlorhexidine (CHX) (commonly known by the salt forms chlorhexidine gluconate and chlorhexidine digluconate (CHG) or chlorhexidine acetate) is a disinfectant and antiseptic that is used for skin disinfection before surgery and to sterilize surgi ...

- if sensitive or allergic to the former), surgically draped and placed in the Lloyd-Davies position. Note: throughout the duration of the procedure, the patient's legs will be massaged and manipulated at predetermined intervals in an attempt to prevent

compartment syndrome Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the ...

, a complication from circulatory and nerve compression resultant from the

lithotomy position The lithotomy position is a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of ...

ing. Some hospitals utilize the Allen Medical Stirrup System, which automatically inflates a compression sleeve applied to the thigh-portion of the stirrup device at predetermined intervals. This system is designed to prevent compartment syndrome in surgeries lasting more than six hours. At this time the surgical team will perform testing to determine if the anesthesia has taken effect. Upon satisfactory finding(s), a suprapubic catheter (with drainage system) will be inserted into the urinary bladder (to create urinary diversion during the procedure), and the chosen procedure will then be initiated. Note: The surgical procedures listed below may have small variances in the methodology used from surgeon to surgeon. Consider the following as a generalized description of each individual procedure, although every precaution was taken to ensure the accuracy of the information.

Types of operations

The choice of procedure is dependent on factors including: * physical condition of the patient * overall condition of the remainder of the urethra (not affected by the stricture) * the length of the defect (best determined by

urethrography A retrograde urethrography is a routine radiologic procedure (most typically in males) used to image the integrity of the urethra. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture. Uses Some indi ...

) * multiple or misaligned strictures * anatomical positioning of the defect with regard to the

prostate gland The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and physio ...

urinary sphincter The urethral sphincters are two muscles used to control the exit of urine in the urinary bladder through the urethra. The two muscles are either the male or female external urethral sphincter and the internal urethral sphincter. When either of t ...

, and

ejaculatory duct The ejaculatory ducts (''ductus ejaculatorii'') are paired structures in male anatomy. Each ejaculatory duct is formed by the union of the vas deferens with the duct of the seminal vesicle. They pass through the prostate, and open into the ureth ...

* position of the most patent area of the urethral wall (necessary for determination of the location of the onlay/graft site, most often dorsal or ventral) * complications and scarring from previous surgery(ies), stent explantation (if applicable), and the condition of the urethral wall * availability of

autograft Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogene ...

tissue from the

buccal cavity The buccal space (also termed the buccinator space) is a fascial space of the head and neck (sometimes also termed fascial tissue spaces or tissue spaces). It is a potential space in the cheek, and is paired on each side. The buccal space is super ...

(buccal mucosa) (primary selection) * availability of

tissue from the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...

and

scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum cont ...

(secondary selection) * skill level and training of the surgeon performing the procedure ''Note: in more complex cases, more than one type of procedure may be performed, especially where longer strictures exist.''

Anastomotic urethroplasty

In this single-stage procedure the urethra will be visualized (in the area of the defect), and the incision will be started at its mid-line (usually) using a bovie knife to dissect the dermal and sub-dermal layers until the associated musculature, corpus cavernosum,

corpus spongiosum The corpus spongiosum is the mass of spongy tissue surrounding the male urethra within the penis. It is also called the corpus cavernosum urethrae in older texts. Anatomy The proximal part of the corpus spongiosum is expanded to form the uret ...

, and

ventral Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek language, Greek roots, describe something in its standard anatomical position. Th ...

urethral The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

aspects are exposed. Particular care is used during the dissection to prevent damage to nerves and blood vessels (which could result in erectile dysfunction or loss of tactile sensation of the penis). The area of the defect is evaluated and marked both mid-line (laterally), and at the distal and proximal borders (transversely). Marked/labeled positioning sutures are secured (one, each) at the

proximal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

and

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

ends of the mid-line area of urethra closest to the

bisection In geometry, bisection is the division of something into two equal or congruent parts, usually by a line, which is then called a ''bisector''. The most often considered types of bisectors are the ''segment bisector'' (a line that passes through ...

points. Using an index finger, the urethra is gently separated from the cavernosum, and a specially designed retractor is then placed behind the urethra (to protect vulnerable areas from damage during the transecting and removal of the urethral defect. The now patent ends of the urethra are prepared using a technique called "spatulation", which (essentially) allows for the end-to-end anastomosis to adjust to the differing diameters of the urethra. A silicone catheter is inserted through the penis and (temporary) distal-urethral end, and threaded into the (temporary) proximal-urethral end, leaving a wide loop for the surgeon to have access to the dorsal urethral aspect for micro-suturing, and start of the anastomosis. The dorsal one-third of the urethral anastomosis is begun, completed, and the catheter is retracted slightly to allow for its positioning within the pre-anastomosed urethra. At this time, using micro surgical technique, the anastomosis is completed and

fibrin glue Fibrin glue (also called fibrin sealant) is a surgical formulation used to create a fibrin clot for hemostasis, cartilage repair surgeries or wound healing. It contains separately packaged human fibrinogen and human thrombin. Medical uses This ...

is applied to the anastomotic suture line to help prevent leakage and

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

formation. The silicone guide catheter will then be withdrawn from the penis and (a) replaced by an appropriately sized Foley catheter (and urinary drainage system), and the incision closed (layer by layer). Some surgeons will inject a

local anesthetic A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

such as 2% plain

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...

or 0.5%

bupivicaine Bupivacaine, marketed under the brand name Marcaine among others, is a medication used to decrease feeling in a specific area. In nerve blocks, it is injected around a nerve that supplies the area, or into the spinal canal's epidural space. It ...

Buccal mucosal onlay graft of the ventral urethra

, and

aspects are exposed. (a) Particular care is used during the dissection to prevent damage to nerves and blood vessels (which could result in erectile dysfunction or loss of tactile sensation of the penis). The area of the defect is evaluated and marked laterally mid-line, and (marked) positioning sutures are positioned (one, each) at the

and

ends of the area of urethra closest to border of the defective area. Simultaneously, a urological surgeon who is specifically trained in

buccal mucosa The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed ''lamina propria''. The oral cavity has sometimes been describ ...

l harvesting techniques will begin harvest and repair of a section of the inside cheek of the patient, corresponding to the dimension/shape calculated and requested by the surgeon performing the urethral aspect of the procedure. When available, an oral/maxillofacial surgeon or ENT specialist will harvest the buccal mucosa in accordance with those requested specifications. Upon retrieval, the buccal graft is presented to the urethral surgeon, who will then prepare the graft by trimming and removal of extraneous tissue. The surgeon will create an incised opening laterally between the known outer borders of the defect, retract the incised opening to the desired diameter, and position the graft to cover the incision. This will form a tunnel, or diversion through the stricture which is 10 mm (optimally) in estimated diameter, to allow for the flow of urine. Using micro surgical techniques, the buccal graft will be sutured in place and

applied to the suture line to prevent leakage and formation of a

. At this time an appropriately sized (a) Foley catheter will be inserted through the repair and into the bladder (and connected to a urinary drainage system), and the incision closed (layer by layer). Some surgeons will inject a

such as 2% plain

or 0.5%

into the areas to allow the patient an additional period of relief from discomfort. Micro-doppler circulatory measurement of the penile vasculature is performed at way points throughout the procedure, and a final assessment is taken and recorded. The incision is inspected and dressed, and the patient is discharged to recovery. (a) At this time, some surgeons prefer to insert a safety guide (as used in urethrotomy) from the urinary meatus, through the stricture, and into the bladder for purposes of maintaining positioning. (b) some surgeons prefer the use of a suprapubic catheter, as they believe insertion of an in-dwelling urethral catheter may damage the surgically repaired area. ''Expected average success rate:'' The success rate for this procedure is between 87 and 98%, buccal mucosal onlay urethroplasty is considered the best of repair options for strictures greater than 2 cm in length. Within recent years, surgeons have been applying the onlay to the dorsal aspect of the urethra with great success. Buccal mucosa best approximates the tissue which composes the urethra.

Scrotal or penile island flap (graft) of the ventral urethra

, and

and

ends of the area of urethra closest to border of the defective area. The surgeon will then harvest a section of tissue from the scrotum or penile foreskin (or what remains in circumsised males) corresponding to the previously determined dimension/shape. Upon retrieval, the graft is prepared for attachment by trimming and removal of extraneous tissue. The surgeon will create an incised opening laterally between the known outer borders of the defect, retract the incised opening to the desired diameter, and position the graft to cover the incision. This will form a tunnel, or diversion through the stricture which is 10 mm (optimally) in estimated diameter, to allow for the flow of urine. Using micro surgical techniques, the scrotal graft or penile island flap will be sutured in place and

applied to the suture line to help prevent leakage and formation of a

. At this time an appropriately sized (b) Foley catheter will be inserted through the repair and into the bladder (and connected to a urinary drainage system), and the incision closed (layer by layer). Some surgeons will inject a

such as 2% plain

or 0.5%

into the areas to allow the patient an additional period of relief from discomfort. Micro-doppler circulatory measurement of the penile vasculature is performed at way points throughout the procedure, and a final assessment is taken and recorded. The incision is inspected and dressed, and the patient is discharged to recovery. (a) At this time, some surgeons prefer to insert a safety guide (as used in urethrotomy) from the urinary meatus, through the stricture, and into the bladder for purposes of maintaining positioning. (b) some surgeons prefer the use of a suprapubic catheter, as they believe insertion of an in-dwelling urethral catheter may damage the surgically repaired area ''Expected average success rate:'' The success rate for this procedure is between 70% and 85%, scrotal or penile island flap urethroplasty is considered the least attractive of repair options for urethral defects, it is, however, the standard procedure used in the repair of strictures greater than 4 cm in length. As with the buccal mucosal onlay, surgeons have been performing the dorsal aspect procedure since the late 1990s, with an estimated success rate approaching 90%.

Johansen's urethroplasty

The Johansen's procedure sometimes referred to as "Johanson's urethroplasty" is a two-stage procedure which was developed during the 1950s and 1960s by Swedish surgeon Dr. Bengt Johansen, and was originally designed as a surgical repair for

hypospadias Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location in the head of the penis. It is the second-most common birth abnormality of the male reproductive system, affecting abou ...

. Over the years, the surgery has evolved into a fairly complex operation whereby the damaged area of the urethra is opened ventrally and left open as a buried skin strip with a deep diversion created from scrotal or penile skin covering the area of the repair. An appropriately sized in-dwelling catheter is inserted, and the repaired area is temporarily closed (sutured in some locations, with packing and dressings in others) until the newly created diversion forms completely, usually within six months. Upon the confirmation of completed healing, the catheter is withdrawn and the surgical site closed permanently. There are numerous methods attributed to the name "Johansen's". Most severe urethral trauma is reconstructed using the Johansen's urethroplastic procedure. It is also the procedure normally utilized in the repair of damage caused by balanitis

lichen sclerosus Lichen sclerosus (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals (penis, vulva) and is also known as balanitis xerotica obliterans (BXO) when ...

, also referred to as

balanitis xerotica obliterans Lichen sclerosus (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals (penis, vulva) and is also known as balanitis xerotica obliterans (BXO) when ...

. The Johansen's procedure is used in the most difficult of traumatic reconstruction cases. Because of the variations of practice within this procedure, an estimated success rate is not available.

Post-procedural care

Constant monitoring of

including

pulse oximetry Pulse oximetry is a noninvasive method for monitoring a person's oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy (within 4% accuracy in 95% of cases) of the more accurate (and invasive) reading of ...

cardiac monitoring Cardiac monitoring generally refers to continuous or intermittent monitoring of heart activity to assess a patient's condition relative to their cardiac rhythm. Cardiac monitoring is usually carried out using electrocardiography, which is a noninv ...

(

ECG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...

body temperature Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature ...

and

blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...

are carried out by the anesthesia practitioner until the patient is discharged post-operatively to the post-surgical recovery unit. After sufficient awakening from the anesthetic agent has taken place, and if the patient is a candidate for same day discharge, he (and the person responsible for his transport home) will be instructed in the care and emptying of the catheter and its drainage system, cleansing of the involved area(s) and methods/intervals for dressing change, monitoring for signs of infection and for signs of catheter blockage. The patient will be given prescriptions for an antibiotic or anti-infective agent, a urinary anti-spasmodic, and a mild to moderate

pain medication An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It i ...

(no more than a few days worth of pain is expected). The patient will be instructed to optimize bed rest for the first two days after the operation, be limited to absolutely no lifting, and instructed to consume a high fiber diet and use a stool softener such as

polyethylene glycol Polyethylene glycol (PEG; ) is a polyether compound derived from petroleum with many applications, from industrial manufacturing to medicine. PEG is also known as polyethylene oxide (PEO) or polyoxyethylene (POE), depending on its molecular we ...

to help in avoiding straining during evacuation. After days 1 and 2, the patient will be instructed to sensibly increase physical activity, and avoid becoming sedentary. Adequate hydration is essential during the post-recovery phase of the procedure. In accordance with the preference of the surgeon, a retrograde urethrogram will be scheduled to coincide with the anticipated removal date of the suprapubic or Foley catheter (usually 7 to 14 days post-procedure, however some surgeons will attempt removal in 3 to 5 days). At 10 days post procedure, the suture line(s) will be evaluated, and the sutures removed if applicable (in many cases, the surgeon will utilize absorbable sutures, which do not require removal). The length of hospitalization is usually determined by the: * status/condition of the patient, post recovery * after-effects of the anesthesia/sedation/spinal anesthesia utilized during the procedure * anticipated post-surgical care, per care plan (dressing changes, packing changes, and monitoring of (any) surgical drains - if used) * monitoring of the newly established urethral cystostomy (Johansen's urethroplasty) ''if applicable'' * monitoring of the suprapubic catheter or

Foley catheter In urology, a Foley catheter (named for Frederic Foley, who produced the original design in 1929) is a flexible tube that a clinician passes through the urethra and into the bladder to drain urine. It is the most common type of indwelling urina ...

for signs of infection and proper urine output ''if applicable'' * titration of

palliative Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...

and anti-spasmodic medication(s) ''if applicable'' * post surgical complications ''if any''

Possible post surgical complications

Note: Urethroplasty is generally well tolerated with a high rate of success, serious complications occur in fewer than ten percent of patients though complications particularly recurrences are commoner in long and complex strictures. * recurrence of the stricture *

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

urinary incontinence Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geria ...

(symptoms of incontinence often improve over time with strengthening exercises) *

urinary retention Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladd ...

requiring intermittent

catheterization In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cath ...

to completely empty the urinary bladder *

erectile dysfunction Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction in which the penis fails to become or stay erect during sexual activity. It is the most common sexual problem in men.Cunningham GR, Rosen RC. Overview of male ...

* loss of penile sensation, decreased tactile sensation of the penile shaft and corona *

retrograde ejaculation Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the releas ...

, changes in ejaculation, and decrease in intensity of orgasm *

referred pain Referred pain, also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in th ...

* urinary

* urinary urgency * urine spraying *

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...

* external bleeding (from the suture line(s)) * bleeding from the internal suture lines (seen as bloody discharge from the urethra)

Research

Urethrotomy vs. urethroplasty

Comparing the two surgical procedures, a UK trial found that both urethrotomy and urethroplasty are effective in treating urethral stricture in the bulbar region. At the same time the more invasive urethroplasty had longer-lasting benefit and was associated with fewer re-interventions. The results were integrated into the new UK guidelines on the treatment urethral narrowing by

British Association of Urological Surgeons The British Association of Urological Surgeons is a professional association in the United Kingdom for urology professionals. Its official journal is the BJU International ''BJU International'' (or ''BJUI'', formerly known as the ''British Jou ...

References

External links

The Center for Reconstructive Urology at UC Irvine

Urethral Stricture Support Group
{{Urologic procedures Urologic surgery