Outcome analysis and decision tree in the management of obliterated non-traumatic anterior urethral strictures: a case series

Abstract Background The obliterated strictures in the anterior urethra are not uncommon. We describe a case series of 45 patients of obliterated strictures, their outcome analysis and postulate a management algorithm. Methods Urethral reconstruction was done in all the 45 patients from February 2015 to March 2019 at a single center. The prospectively collected data were evaluated retrospectively with symptom score, uroflowmetry, post void residue (PVR) and urethrogram. The lumen size, length of stricture and the degree of spongio-fibrosis were assessed. The strictures were subclassified into nearly obliterated stricture (NOS) and completely obliterated stricture (COS) based on the urethral lumen size. The patients were followed initially quarterly and yearly after. Any intervention needed was considered as failure. Results The average age was 49 years (IQR 31 to 67). The etiology was iatrogenic in 30 (67%) and Lichen Sclerosus (LS) in 13 (29%) and necrotizing scrotal infection in 2 (4%). There were 24 (53%) COS and 21 (47%) NOS. Seven management categories and their management decision tree are described. The average follow-up was 34 months (IQR 12–58). Overall average symptom score, flow rate and PVR improved from 21 to 7, 6 ml/s to 19 ml/s and 210 ml to 20 ml, respectively. Six patients (13%) developed minor complications. Recurrence was noted in six (13%). Conclusions Obliterated strictures are complex and challenging. A systematic approach as described, may be taken to manage them for a successful outcome with a reasonable complication and recurrence rate.