Optimising treatment of male urethral stricture disease

Urethral strictures are still a challenging pathology for the urologist. Study 1 closely evaluates the aetiology of urethral stricture disease. It has been shown that aetiology of urethral strictures is significantly different among patients’ age and stricture location. When comparing the results of the present study with historical data or data of developing countries, some preventable causes of urethral strictures can be suggested. Study 2 shows that DVIU can also be used for short urethral strictures after phallic reconstruction. The only significant factor for the success or failure was the time between phalloplasty and DVIU. Study 3 indicates that ventral only urethroplasty with a graft provides good results for bulbar urethral strictures. These results are comparable to the results of dorsal onlay urethroplasty. In study 6, it was also observed that the results of ventral and dorsal onlay free graft urethroplasty are similar. Studies 3 and 6 also show that preputial skin as graft provides similar results compared to buccal mucosa. Study 4 and 5 evaluate respectively traumatic and non-traumatic posterior urethral strictures. These studies reveal that anastomotic repair by perineal route only is an excellent way to treat these strictures. Study 4 suggests that previously failed urethral manipulations are related with a higher risk of complications and failure of the urethroplasty. Study 6 mainly focusses on the choice of technique in urethroplasty. This study shows that the techniqu is adapted to the local circumstances of the stricture. The lack of international-accepted definitions, classifications and guidelines are a recurrent observation in all our studies. This thesis is a plea for the creation of international-accepted definitions, classifications and treatment guidelines for urethral strictures, that are if possible supported by prospective randomised trials.