![]() Index of suspicion for urethral stricture disease should be high in patients with obstructive voiding symptoms especially younger patients and older men who do not respond to alpha blocker medication, a history of trauma, transurethral surgery, prior prostate cancer treatment, prior hypospadias repair, and lichen sclerosis. Patient assessment and indication for intervention ![]() Overall, urethral stricture disease is common, with a reported prevalence as high as 600 per 100,000. 3 Inflammatory strictures are commonly associated with lichen sclerosis also known as balanitis xerotica obliterans, which can be associated with panurethral stricture disease, which is generally not responsive to endoscopic management. In contemporary series, however, common causes include straddle trauma, pelvic fracture urethral injury, instrumentation, prior hypospadias surgery, and prior prostate surgery, and/or radiation. Historically, inflammation and untreated sexually transmitted gonococcal infections were considered a primary cause of strictures. More severe cases may present with complete retention, bladder stones, or recurrent urinary tract infections (UTIs). Symptoms become more common as the caliber decreases to less than 16F, and most strictures are less than 10F to 12F in caliber. As the lumen reduces from its normal caliber (∼30F except in the fossa navicularis where the normal caliber is 22F–24F), voiding dysfunction and obstructive symptoms will occur. Anterior urethral stricture disease refers to a severe scarring process that occurs in the corpus spongiosum (spongiofibrosis) and ultimately results in narrowing of the urethra.
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