Stricture Penile Urethra

50 year patient has history of accidental pull out of foley urethral catheter with balloon inflated.

At present very poor urinary stream.
History of DM, under control with medicines.
I am attaching RGU image.
Please discuss management options....

Stricture Penile Urethra


  • Rahul Kapoor
    Rahul Kapoor
    05 Jun 2020 01:03:35 PM

    I will plan a dorsal onlay urethroplasty. 

    In todays time, preputial skin will be first option if favourable

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    05 Jun 2020 01:19:18 PM

    I would like to add two more test sir,

    1/MCU want to know bladder neck status
    2/ urethrocystoscopy by 6 fr flexible urethrocystoscopy or by 7 fr ureteroscope...
    Want to classify it calibre as less then 6 fr or less than 3 fr..if less than 3 fr... multistage procedure... Johanson stage 1..ashopa stage 2.
    If..less than 6fr... would like to do dorsal only bmg...

  • Dr. Anil Takvani
    Dr. Anil Takvani
    05 Jun 2020 01:32:19 PM

    @ Tikenjit,

    How will you insert flexible URS in stricturous penile urethra?
    Please just don't mention operation names, write your plan in detail.

  • Lalit Shah
    Lalit Shah
    05 Jun 2020 01:47:44 PM

    Looks like a self inflected pan urethral stricture.

    Counselling , informed shared decision.
    1/-BMG pan urethroplasty,
    But at present during Covid time, I would prefer to avoid BMG, more so long segment at least for a month or two,
    If patient/attendants are understanding and willing, SPC to buy time.
    Before surgery urethroscopy with small URS would be helpful.
    If caliber more than 6-8 F at most part of length, single stage Kulkarni technique.
    Else lay open stage one, after 3-6 months stage two, BMG at stage two( not at stage one)
    2/- Though young, but still option of perineal urethrostomy would be explained.
    Many Indian patients from remote areas etc would prefer high a one time solution with high chances of success.

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    05 Jun 2020 01:47:47 PM

    Yes sir,we need to calibre te to classify .. endoscopic ly...if it's complete question of putting a needs stage procedure....but..I can see dye has gone in...some calibre is need calibration by ureteroscope or small flexible scope to define's will decide if stage procedure or single stage procedure.

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    05 Jun 2020 01:54:49 PM

    Somemore history will be helpful,urinary stream,straing urinary obstruction....creatine level...if anything..would advise him for SPC..

    Definate operation after 3 months .
    If passing urine per urethra...wolud like to add usg bladder for bladder wall thick ness n pvr .or upper track abnormalities..if anything...would advise him on SPC

  • Dr. Anil Takvani
    Dr. Anil Takvani
    05 Jun 2020 04:20:36 PM

    RFT normal 

    No sepsis 
    Upper tracts normal, 165 cc PVR 
    Severe outflow obstructive symptoms. 

    @Lalit Sir,  thanks.

    05 Jun 2020 06:39:33 PM

    Agree with comments of Dr Lalit Shah 

    This is long stricture 
    Needs dorsal approach Kulkarni technique
    If someone was passing urine well and now poor flow , It’s most likely because of stricture in this patient 
    Buccal graft better than Preputial 

  • Dr. Anil Takvani
    Dr. Anil Takvani
    05 Jun 2020 07:39:00 PM

    @ Dr. Pankaj,

    Have you started harvesting buccal mucosa for stricture urethroplasty?
    Whith what precausions?

  • Nitesh Jain
    Nitesh Jain
    05 Jun 2020 07:57:48 PM

    When was the catheter pulled out , I feel it’s important as would like to wait for 12 weeks before the inflammation settles 

    Dorsolateral onlay BMGU with penile invagination Will be my choice 

  • Dr. Anil Takvani
    Dr. Anil Takvani
    05 Jun 2020 08:23:28 PM


    8 to 9 months before. 
    Why dorsolateral?

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