Post-traumatic posterior urethral stricture: clinical considerations

Post-traumatic urethral stricture is a common challenging problem, usually associated with pelvic fracture. There are many questions on its proper management such as proper pre-operative evaluation, maximum length of the defect to be operated by perineal approach, whether urethral realignment on first encounter of urethral injury should be performed, and the best way for managing children with the disease. The aim of that review is to find the proper answers to these challenging questions and to provide some simple tips that can help to achieve a higher success rate. English literature on post-traumatic posterior urethral stricture, both in adults and pediatric age groups, were reviewed from Medline. Five questions was thought to be challenging for urologists on confronting a case of post-traumatic posterior urethral stricture, and answers for those questions could be achieved on the review of work of eminent urologists concerned with such challenging problem. Pre-operative evaluation of every case of urethroplasty should combine at least three modalities; combined retrograde urethrogram and cystogram, urethral ultrasound and endoscopic study. There are certain tips to be taken before and during surgery helping to improve the outcome, including sterile urine and tension-free anastomosis. Most authors agree on 2.5 cm to be a safe defect length to achieve tension-free anastomosis. Primary realignment is a simple procedure that may decrease the need of surgical intervention. Perineal urethroplasty can be applied in children similar to adults.