Management of Recurrent Urethral Strictures

Abstract

Stricture recurrence, either after previous dilation/urethrotomy or urethroplasty, can be complex. After failed urethrotomy/dilation, we generally perform a urethroplasty. After urethroplasty, failures are treated with a single DVIU, because of a reported rate of lasting success which may be as high as 50 %. After failure of this initial salvage DVIU, we generally plan redo urethroplasty. For most urethral strictures, this will be a buccal urethroplasty. If the patient had a previous buccal urethroplasty, the redo surgery is done on the opposite side of the urethra (initial urethroplasty = ventral, then redo urethroplasty = dorsal). Patients with urethral obliteration may need a modified roof strip anastomotic technique. In rare cases of short bulbar stricture, redo EPA may be done. In patients with previous staged Johanson urethroplasty, especially in patients with hypospadias, failures may be treated with redo staged Johanson urethroplasty. In patients with failed PFUI repair, a redo PFUI can be performed with very high success rates.