Contemporary urethral stricture characteristics in the developed world

Objective: To assess the current etiology, features, and natural history of urethral stricture disease in the developed world. Materials and Methods: We analyzed the data from 1439 male patients with urethral stricture, who had undergone surgical treatment in our referral urethral center from 2000 to 2010. The preoperative evaluation included a detailed clinical history of stricture, uroflowmetry, retrograde and voiding cystourethrography, and urethroscopy. Statistical analysis was done for the stricture site, length, and etiology, patient age, and previous treatments. Results: Strictures were posterior in 112 (7.8%) and anterior in 1327 (92.2%). In the anterior group, 439 were penile (30.5%), 675 bulbar (46.9%), 71 penile plus bulbar (9.9%), and 142 panurethral (4.9%). The main causes were iatrogenic in 556 (38.6%), unknown in 515 (35.8%), lichen sclerosus in 193 (13.4%), and trauma in 156 (10.8%). The main iatrogenic strictures were from catheterization in 234 (16.3%), hypospadias repair in 176 (12.2%), and transurethral surgery in 131 (9.1%). The stricture distribution increased until about 45 years and then decreased. Strictures were uncommon in those <20 and >70 years old. The mean length was 4.15 cm; longer strictures were found in those with lichen sclerosus (7.45 cm) or after hypospadias repair (4.42 cm) and catheterization (4.40 cm). The mean length was also greater in the pretreated (4.34 cm) than in the untreated (3.64 cm) strictures. Conclusion: Urethral stricture in developed countries mainly involves the anterior urethra, in particular the bulbar tract. The most common cause was iatrogenic. Hypospadias repair and lichen sclerosus represent emerging important causes. Finally, urethral stricture is not a disease of the elderly but involves all ages.