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Advances in Urology
Volume 2015 (2015), Article ID 853914, 15 pages
http://dx.doi.org/10.1155/2015/853914
Review Article

Management of Long-Segment and Panurethral Stricture Disease

1Department of Urology, Hospital Santa Maria, University of Lisbon, School of Medicine, 1600-161 Lisbon, Portugal
2ULSNA-Hospital de Portalegre, 7300-074 Portalegre, Portugal
3Kulkarni Reconstructive Urology Center, Pune 411038, India
4City of Hope Medical Center, Duarte, CA 91010, USA

Received 10 October 2015; Accepted 5 November 2015

Academic Editor: Kostis Gyftopoulos

Copyright © 2015 Francisco E. Martins et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection), previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient.