Urethral Stricture Disease: Challenges and Ongoing Controversies

Management of urethral stricture disease presents constant challenge for all reconstructive urologists. Urethral stricture disease is generally defined as stenoses that are typically long, involving broad areas of varying spongiofibrosis, and result from inflammation and/or infection, rather than trauma. Although the management of urethral strictures may be complex and challenging, very often they are treated by health care personnel without the necessary and proper training and knowledge of the current, modern, validated techniques and procedures. Notable changes in surgical approach have been adopted worldwide, resulting in significant improvement of successful outcomes and simultaneously decreasing the complication rate. Nowadays, most urethral strictures can be reconstructed in a one-stage procedure, leaving some complex cases for a less convenient, but safer, two-stage repair strategy. The exciting and enjoyable " nature " of recon-structive surgery, in general, and urethral reconstruction, in particular, is the unexpected and unpredictable nature of the stricture and, consequently, the need for the creative combination of different techniques and strategies, often involving tissue transfer procedures, either as grafts or as flaps, for achieving a successful outcome. This special issue contains a number of articles with description of different aspects, presentations, and treatments of urethral stricture disease with the aim to make further improvement of understanding and managing this severe surgical condition. Multi-institutional review article from Portugal, India, and USA presents modality of challenging treatment of long-segment and panurethral stricture disease. Francisco E. Martins and colleagues evaluated etiology, pathogenesis, and diagnostic work-up and, finally, presented different surgical options for treatment, together with outcomes and complications. They concluded that one-stage repair with buccal mucosa grafts presents an excellent option in the treatment of long urethral stricture. However, for obliterative disease, two-stage urethroplasty offers a viable alternative. J. Gelman and E. S. Wisenbaugh presented a review article about management of patients who suffer pelvic fracture urethral injuries which usually develop into obliterative strictures with distraction defect. They comprehensively evaluated initial management, preoperative planning, and techniques for posterior urethral stricture disease. The authors emphasize the importance of adequate vascularization of urethra for successful repair. They believe that possible future modification of operative technique could be a bulbar artery sparing surgery during posterior urethral reconstruction. Results from referral centers confirm that when open repair fails, excision and primary anastomosis still remains the procedure of choice and offers a very high success rate. In another article entitled " The Use of Flaps and Grafts in the …