Management of 7 cm Urethral Stricture After TURP
For a 7 cm urethral stricture after TURP, urethroplasty is the recommended definitive treatment due to the length of the stricture and high failure rates of endoscopic approaches for strictures >2 cm. 1, 2
Initial Assessment and Temporary Management
- Confirm the diagnosis and determine exact stricture characteristics using urethro-cystoscopy, retrograde urethrography (RUG), voiding cystourethrography (VCUG), or ultrasound urethrography 1, 2
- For immediate urinary drainage, a suprapubic cystostomy may be placed to provide "urethral rest" prior to definitive urethroplasty 1
- Urethral rest via suprapubic cystostomy promotes tissue recovery and stricture maturation over 4-6 weeks, enabling accurate assessment for definitive management 1
Treatment Selection Based on Stricture Length
- For strictures >2 cm (and especially for a 7 cm stricture), endoscopic management has very low success rates 1, 2
- Success rates for endoscopic treatment of strictures >4 cm are only about 20% 2
- Urethroplasty offers significantly higher long-term success rates (73-90%) compared to endoscopic approaches for longer strictures 2, 3
Urethroplasty Technique Considerations
- For post-TURP strictures involving the proximal bulbar urethra close to the membranous urethra, a ventral approach is often best suited 3, 4
- Buccal mucosa graft (BMG) urethroplasty is safe, feasible, and offers long-term success in post-TURP stricture patients 3
- Modified ventral onlay graft urethroplasty using non-aggressive techniques can help preserve urinary continence in patients with sphincter involvement 4
Why Not Endoscopic Management?
- Repeated endoscopic treatments (dilation or DVIU) for long strictures have failure rates exceeding 80% 1
- Multiple endoscopic procedures may cause longer strictures and increase the complexity of subsequent urethroplasty 1, 2
- For strictures of this length (7 cm), direct progression to urethroplasty avoids the futility and potential complications of repeated endoscopic interventions 1, 2
Common Pitfalls to Avoid
- Attempting multiple endoscopic procedures for long strictures delays definitive treatment and may worsen outcomes 1
- Failure to accurately assess stricture length and location before treatment selection can lead to inappropriate management decisions 1, 2
- Not considering urinary continence preservation techniques during urethroplasty, especially if the stricture involves the sphincter region 4
Special Considerations
- If the patient is not a candidate for urethroplasty due to comorbidities or patient preference, a suprapubic catheter for long-term management or intermittent self-catheterization after DVIU may be considered as palliative options 1
- Surgeons who do not perform urethroplasty should refer patients to centers with expertise in reconstructive urethral surgery 2