Panurethral Strictures: A Review of Management Options

Introduction: Panurethral strictures represent a complex subgroup of urethral strictures. Lichen sclerosis is the commonest cause for these strictures. We outline the management of panurethral strictures in this review. Material and Methods: Our institute is a tertiary referral center. We evaluated panurethral strictures (primary and redo cases) managed at our institute over the last 20 years (June 1995-June 2015) using single stage Kulkarni one- sided urethroplasty with oral mucosal graft. Patients with incomplete medical records were excluded from the study. Data was analysed for primary or redo case, age, cause of stricture, length of stricture, follow up and success rate. Success was defined as no requirement of any further intervention. Follow up was carried out every 3 months in the first year and every year thereafter. Follow up included clinical examination and uroflow. This is a non-analytic study and descriptive analysis was carried out. Results: 318 (283 primary and 35 redo) cases of panurethral strictures were managed at our institute over last 20 years. Lichen sclerosis was seen in 184 (57.84%) cases. 84.9% (primary 89.39% and redo 57.85%) cases were successful. Age range of patients was 20-76 years (median 44.6 years) with stricture length from 10-19 cms. Follow up was at regular intervals using uroflow assessment. Median follow up was 59 months (range 6.4 to 192). Conclusion: Lichen sclerosis is the commonest cause for panurethral strictures. Kulkarni one-sided panurethroplasty offers a single stage surgery with acceptable outcomes and avoids inclusion of genital skin as seen in staged procedures