These are nearly always done in a single setting (or stage).In the penile urethra, anastomotic urethroplasties are rare because they can lead to chordee (penile curvature due to a shortened urethra). Instead, most penile urethroplasties are substitution procedures utilizing buccal mucosa graft, full-thickness skin graft, or split-thickness skin graft. These can be done in one or more settings, depending on stricture location, severity, cause and patient or surgeon preference. Urethral stent
A permanent urethral stent was approved for use in men with bulbar urethral strictures in 1996, but was recently removed from the market.A temporary thermoexpandable urethral stent (Memotherm) is available in Europe but is not currently approved for use in the United States. Emergency treatment
When in acute urinary retention, treatment of the urethral stricture or diversion is an emergency. Options include:

Urethral dilatation and catheter placement. This can be performed in the Emergency Department, a practitioners office or an operating room. The advantage of this approach is that the urethra may remain patent for a period of time after the dilation, though long-term success rates are low. Insertion of a suprapubic catheter with catheter drainage system. This procedure is performed in an Operating Room, Emergency Department or practitioners office. The advantage of this approach is that it does not disrupt the scar and interfere with future definitive surgery. Ongoing care
Following urethroplasty, patients should be monitored for a minimum of 1 year, since the vast majority of recurrences occur within 1 year.
Because of the high rate of recurrence following dilation and other endoscopic approaches, the provider must maintain a high index of suspicion for recurrence when the patient presents with obstructive voiding symptoms or urinary tract infection. Research
Urethrotomy vs. urethroplasty
Comparing the two surgical procedures, a UK trial found that both urethrotomy and urethroplasty are effective in treating urethral narrowing in the bulbar region. At the same time the more invasive urethroplasty had longer-lasting benefit and was associated with fewer re-interventions. The results were integrated into the new UK guidelines on the treatment urethral narrowing by British Association of Urological Surgeons. Bioengineering
The use of bioengineered urethral tissue is promising, but still in the early stages. The Wake Forest Institute of Regenerative Medicine has pioneered the first bioengineered human urethra and in 2006 implanted urethral tissue grown on bioabsorbable scaffolding (approximating the size and shape of the affected areas) in five young (human) males who had congenital defects, physical trauma, or an unspecified disorder necessitating urethral reconstruction. As of March, 2011, all five recipients report the transplants have functioned well. Cell therapy approach through endoscopy
Buccal mucosal tissue harvested under local anesthesia after culturing in the lab when applied through endoscopy after urethrotomy in a pilot study has yielded encouraging results. This method named as BEES-HAUS procedure needs to be validated through a larger multicentric study before becoming a routine application. References


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