Is urethral stricture only a circumferential disease? Reason for change in the plan of urethroplasty for bulbous urethral strictures shorter than 2 cm

OBJECTIVE: To understand the reasons for choosing the type of urethroplasty for bulbous strictures shorter than 2 cm in length that were ideally suited for anastomotic urethroplasty (AU). MATERIALS AND METHODS: Data of adult men, who underwent urethroplasty between November 2002 and September 2011 for isolated bulbous strictures less than 2 cm in length, as measured intra-operatively, were reviewed. Patients who had undergone urethroplasty before were excluded. Data recorded were details of previous interventions, the etiology of the stricture and the type of urethroplasty performed. RESULTS: Out of 277 men who underwent urethroplasty for bulbous stricture, 65 men fulfilled the inclusion criteria. The etiologies were trauma in 24, post catheterization in 16, and idiopathic in 25. The mean stricture length was 1.60 cm (range 0.8 to 1.9). Anastomotic urethroplasty was performed in 41 men (Group 1). In the remaining 24 men, buccal mucosa graft urethroplasty was performed in 20 and augmented AU in 4 (Group 2). Comparing the two groups we found that Group 2 patients had undergone more internal urethrotomies (mean 2.45±0.88 vs. 1.58±0.63; P=0.005) and had longer stricture length as compared to men in Group 1 (mean 1.8±0.83 vs. 1.48±0.23 cm; P=0.005). The reason why AU could not be performed (Group 2) was shortening of the length of the urethra, making mobilization difficult. CONCLUSIONS: Even short strictures are associated with urethral shortening as the fibrosis is not only circumferential but also longitudinal. The surgeon should be prepared for an alternate plan even for bulbous urethral strictures shorter than 2 cm.