Urethral stricture: modern state of the problem. Literature review

Urethral stricture disease is a widespread disease, significantly influencing the quality in life in affected patients. Rehabilitation of the patients with this pathology is linked with substantial costs for healthcare providers. In the last years the terminology of this disease anf the therapeutic approaches were significantly reviewed. The preoperative diagnostical steps, surgical experience and adequate operative planning are crucial for the success of the intervention. In the last two decades endourethral modalities are skeptically regarded. Nevertheless these methods are the most prevalent in the urological world. Anastomotic urethroplasty is a method of choice in patients with short (up to 2-3 cm) single strictures of the bulbous urethra. Efficacy here is more than 90%. The substitution urethroplasty achieves its popularity in the treatment of long (>2 cm) strictures of the bulbous and penile urethra. As for expert opinion, cheek mucosal graft urethroplasty is considered optimal. From the scientific and pathological point of view it would be interesting to study the morphological changes in transposed mucosa. The unsolved problem is as it was earlier the depth and severity of spongiofibrosis. The small number of the good and evidence-based planned studies to the treatment of urethral stricture disease makes the comparison of the European and national guidelines impossible, which warrants the necessary of grounding of the national centers for reconstructive urethral surgery and their organization on the ground of the multicenter prospective studies in this area.