Urethral stricture: etiology, investigation and treatments

The management of urethral stricture after kidney transplantation

OBJECTIVE

To investigate the incidence and causes of urethral stricture after kidney transplantation, as well as analyze its diagnosis, treatment and prevention.

METHODS

Clinical data of patients who developed urethral stricture after living-donor kidney transplantation in our center between January 2007 and June 2012 were retrospectively analyzed.

RESULTS

Urethral stricture occurred in 8 of the 677 eligible kidney recipients (1.18 %) during the study period; the complication occurred at a mean of 4.4 months (range 2-7 months) after transplantation. Cystoscope-related iatrogenic injury and urinary tract infection seemed to be the most likely causes. In addition to frequency and dysuria, three patients had hydronephrosis and four had elevated serum creatinine levels. Urethrography showed that the urethral stricture was anterior in two patients and posterior in the remaining six. Two patients were treated by urethral dilation, four by internal urethrotomy and two by urethra reconstruction surgery. All patients urinated readily after treatment and four patients with impaired renal function recovered.

CONCLUSION

Urethral strictures after kidney transplantation are rare, and they can be safely and effectively treated by urethral dilation, internal urethrotomy or urethra reconstruction. Avoiding iatrogenic injury and shortening catheterization time may help reduce the risk of this complication.

Plastic end-to-end treatment of bulbar urethral stricture

For bulbar urethral strictures up to 2.5 cm in length, the one-stage urethral plastic surgery with stricture excision and direct end-to-end anastomosis remains the best procedure to guarantee a high success rate.

This retrospective review shows the results of 21 patients who underwent bulbar end-to-end anastomosis from 2010–2013.

In 20 cases (95.3%) good results were archived. The criteria of success were identified by pre- and postoperative radiological diagnostics and uroflowmetry.