Urethral strictures can have different causes. In most cases, it is an acquired condition caused by inflammation (urethritis), injury or as a result of endourological procedures or other operations (e.g. radical prostatectomy).

Diagnostic tests include a urine flow measurement (uroflowmetry), an X-ray examination of the urethra and possibly the bladder (urethrogram, cystogram) and, depending on the findings, cystoscopy (urethrocystoscopy).

There are different surgical procedures to treat urethral strictures. Which operation is the right one for each patient depends on the location and length of the stricture on the one hand and whether it is a first manifestation or a recurrence of the urethral stricture on the other. A distinction is made between endoscopic (internal) and open surgical techniques.

Internal urethral incision(urethrotomia interna according to Sachse) is only considered as a treatment for short-segment and first-time urethral strictures. It has a high recurrence rate.

In patients with urethral stricture recurrence and/or a long-segment stricture, open urethroplasty is the gold standard. Depending on the length, location and aetiology of the stricture, an end-to-end anastomosis or urethroplasty with a free graft or a pedicled flap can be performed.

The so-called end-to-end anastomosis can be performed for short-segment stenoses up to a maximum length of 2 cm in the area of the bulbar urethra. The narrowed part of the urethra is cut out and the healthy ends of the urethra are sutured back together.

In the case of longer narrowings or constrictions in the penile urethra, urethroplasty should be performed using a free graft or pedicled flap. Various autologous "materials" are available for this purpose: Oral mucosa, mesh graft (skin graft of the inner thigh), or pedicled skin flaps from the foreskin, penile shaft or scrotum. In the case of complex strictures, it may be necessary to reconstruct the urethra in two stages.

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