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Change in Stricture Length Following Urethral Rest
Madeline Cancian, MD, Kennon Miller, MD.
Brown University, Providence, RI, USA.

BACKGROUND: The 2017 AUA guidelines on male urethral strictures state surgeons may place suprapubic cystotomies (SPC) prior to urethroplasties to permit the full length of the urethral stricture to develop. To our knowledge, there are no studies looking at the evolution of urethral stricture after urethral rest with SPCs in place. Our goal was to document the change in stricture length before and after SPC placement. METHODS: Charts of patients undergoing urethroplasty by a single surgeon (KM) between 1/2007 and 3/2017 were reviewed. Patients who had retrograde urethrograms (RUG) prior to and at least 3 weeks post SPC were included in the study. Statistics were completed use Microsoft Excel. RESULTS: 16 patients with 18 strictures were identified who had pre- and post-SPC RUG. The mean stricture length pre-SPC was 3.0 cm (range 0-8 cm) [Table 1]. The mean stricture length post-SPC was 2.7 cm (range 1-4.5 cm). The mean time of urethral rest prior to repeat RUG was 48 days (range 24-120 days). 33% (6) of the strictures had no change in length, 33% (6) increased in length and 28% (5) decreased in length. Two of the strictures became obliterative after urethral rest. All of the strictures that increased in length were in the bulbar urethra. The mean increase in length was 0.7 cm (range 0.5-1.5) and the mean decrease in length was 1.8 cm (0.5-4.5).
CONCLUSIONS: The length of urethral strictures changes after SPC placed for urethral rest. Bulbar urethral strictures were they only type that increased in size after SPC. This is an important distinction as an increase in bulbar stricture length could change operative technique from an excision and primary anastomosis to a tissue transfer repair. Pre-operative SPC should be considered to allow the stricture to declare itself as stricture length is essential to choice of urethroplasty type.


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