In recent years, several international urological societies have published guidelines on the diagnosis, treatment, and follow-up of urethral strictures, but a guideline for the German-speaking region has not been available to date. This summary provides a detailed comparison of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) with regard to the treatment of anterior urethral strictures, i.e. from the bulbar urethra to the meatus. In the following work, differences and specific recommendations in the guidelines are highlighted. In particular, the three guidelines largely agree with regard to diagnostic workup and follow-up. However, divergences exist in the management of anterior urethral strictures, particularly with regard to the use of endoscopic therapeutic approaches and the use of urethral stents. In addition, the EAU provides more comprehensive and detailed recommendations on urethroplasty techniques and specific patient follow-up. The EAU guidelines are the most current and were the first to include instructions for urethral strictures in women and individuals with gender incongruence after genital approximation surgery. Reconstructive urology is a rapidly evolving specialty and, thus, the clinical approach has been changing accordingly. Although guideline recommendations have become more inclusive and comprehensive, more high-quality data are needed to further improve the level of evidence.

In den letzten Jahren haben verschiedene internationale urologische Fachgesellschaften Leitlinien zur Diagnostik, Behandlung und Nachsorge von Harnröhrenstrikturen veröffentlicht, eine Leitlinie für den deutschsprachigen Raum ist jedoch bis dato nicht verfügbar. Diese Zusammenfassung bietet einen detaillierten Vergleich der Leitlinien der European Association of Urology (EAU), American Urological Association (AUA) und der Société Internationale d’Urologie (SIU) im Hinblick auf die Behandlung anteriorer Harnröhrenstrikturen, also von der bulbären Harnröhre bis zum Meatus urethrae. In der folgenden Arbeit werden Unterschiede und exklusive Empfehlungen in den Leitlinien besonders herausgestellt. Insbesondere in Bezug auf die diagnostische Abklärung und Nachsorge stimmen die drei Leitlinien größtenteils überein. Divergenzen bestehen jedoch beim eigentlichen Management der anterioren Harnröhrenstrikturen, insbesondere in Bezug auf den Einsatz endoskopischer Therapieansätze und die Verwendung von Harnröhren-Stents. Darüber hinaus bietet die EAU umfassendere und detailliertere Empfehlungen zu Urethroplastiktechniken und der spezifischen Nachsorge der Patienten. Die EAU-Leitlinien sind die aktuellsten und die ersten, die Anweisungen für Harnröhrenstrikturen bei Frauen und Personen mit Geschlechtsinkongruenz nach genitalangleichender Operation beinhalten. Die rekonstruktive Urologie ist ein sich rasch weiterentwickelndes Fachgebiet und die klinische Vorgehensweise verändert sich dementsprechend dynamisch. Obwohl die Leitlinienempfehlungen inklusiver und umfassender geworden sind, sind weitere qualitativ hochwertige Daten erforderlich, um das Evidenzniveau weiter zu verbessern.

Department of Urology 2nd Faculty of Medicine Charles University Prag Tschechien

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordanien

Karl Landsteiner Institut für Urologie und Andrologie Wien Österreich

Klinik für Urologie Asklepios Klinik Barmbek Hamburg Deutschland

Klinik für Urologie Universitätsklinikum Frankfurt am Main Frankfurt am Main Deutschland

Klinik und Poliklinik für Urologie Universitätsklinikum Hamburg Eppendorf Martinistr 52 20246 Hamburg Deutschland

Universitätsklinik für Urologie Comprehensive Cancer Center Medizinische Universität Wien Wien Österreich

Zobrazit více v PubMed

Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W (2009) Etiology of urethral stricture disease in the 21st century. J Urol 182:983–987 PubMed DOI

Lumen N, Campos-Juanatey F, Greenwell T, Martins FE, Osman NI, Riechardt S et al (2021) European association of urology guidelines on urethral stricture disease (part 1): management of male urethral stricture disease. Eur Urol 80:190–200 PubMed DOI

Wessells H, Morey A, Souter L, Rahimi L, Vanni A (2023) Urethral stricture disease guideline amendment (2023). J Urol 210:64–71 PubMed DOI

Kulkarni SB, Bhat A, Bhatyal HS, Sharma GR, Dubey DD, Khattar N et al (2021) The urological society of India guidelines for the management of urethral stricture (executive summary). Indian J Urol 37:6–9 PubMed DOI PMC

Rourke KF, Welk B, Kodama R, Bailly G, Davies T, Santesso N et al (2020) Canadian urological association guideline on male urethral stricture. Can Urol Assoc J 14:305–316 PubMed DOI PMC

Morey AF, Watkin N, Shenfeld O, Eltahawy E, Giudice C (2014) SIU/ICUD consultation on urethral strictures: anterior urethra—primary anastomosis. Urology 83:S23–6 PubMed DOI

Stewart L, McCammon K, Metro M, Virasoro R (2014) SIU/ICUD consultation on urethral strictures: anterior urethra-lichen sclerosus. Urology 83:S27–30 PubMed DOI

Buckley JC, Heyns C, Gilling P, Carney J (2014) SIU/ICUD consultation on urethral strictures: dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Urology 83:S18–22 PubMed DOI

Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D (2014) SIU/ICUD consultation on urethral strictures: epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology 83:S1–7 PubMed DOI

Angermeier KW, Rourke KF, Dubey D, Forsyth RJ, Gonzalez CM (2014) SIU/ICUD consultation on urethral strictures: evaluation and follow-up. Urology 83:S8–17 PubMed DOI

Chapple C, Andrich D, Atala A, Barbagli G, Cavalcanti A, Kulkarni S et al (2014) SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology 83:S31–47 PubMed DOI

Abbasi B, Shaw NM, Lui JL, Li KD, Low P, Hakam N et al (2022) Comparative review of the guidelines for anterior urethral stricture. World J Urol 40:1971–1980 PubMed DOI

Kaplan GW, Brock JW, Fisch M, Koraitim MM, Snyder HM (2014) SIU/ICUD consultation on urethral strictures: urethral strictures in children. Urology 83:S71–3 PubMed DOI

Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A et al (2008) Going from evidence to recommendations. BMJ 336:1049–1051 PubMed DOI PMC

Rourke K, Hickle J (2012) The clinical spectrum of the presenting signs and symptoms of anterior urethral stricture: detailed analysis of a single institutional cohort. Urology 79:1163–1167 PubMed DOI

Cotter KJ, Flynn KJ, Hahn AE, Voelzke BB, Myers JB, Smith TG 3rd et al (2018) Prevalence of post-micturition incontinence before and after anterior urethroplasty. J Urol 200:843–847 PubMed DOI

Nuss GR, Granieri MA, Zhao LC, Thum DJ, Gonzalez CM (2012) Presenting symptoms of anterior urethral stricture disease: a disease specific, patient reported questionnaire to measure outcomes. J Urol 187:559–562 PubMed DOI

Barry MJ, Fowler FJ Jr., O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK et al (1992) The American urological association symptom index for benign prostatic hyperplasia. J Urol 148:1549–1557 (discussion 64) PubMed DOI

Donovan JL, Peters TJ, Abrams P, Brookes ST, de aa Rosette JJ, Schafer W (2000) Scoring the short form ICSmaleSF questionnaire. International continence society. J Urol 164:1948–1955 PubMed DOI

Jackson MJ, Sciberras J, Mangera A, Brett A, Watkin N, N’Dow JM et al (2011) Defining a patient-reported outcome measure for urethral stricture surgery. Eur Urol 60:60–68 PubMed DOI

Kluth LA, Dahlem R, Becker A, et al (2016) Psychometric validation of a German language version of a PROM for urethral stricture surgery and preliminary testing of supplementary ED and UI constructs. World J Urol 34(3):369–375 PubMed DOI

Breyer BN, Edwards TC, Patrick DL, Voelzke BB (2017) Comprehensive qualitative assessment of urethral stricture disease: toward the development of a patient centered outcome measure. J Urol 198:1113–1118 PubMed DOI

Kaluzny A, Gibas A, Matuszewski M (2018) Ejaculatory disorders in men with urethral stricture and impact of urethroplasty on the ejaculatory function: a systematic review. J Sex Med 15:974–981 PubMed DOI

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830 PubMed DOI

Rosen RC, Catania J, Pollack L, Althof S, O’Leary M, Seftel AD (2004) Male sexual health questionnaire (MSHQ): scale development and psychometric validation. Urology 64:777–782 PubMed DOI

Riechardt S, Waterloos M, Lumen N, Campos-Juanatey F, Dimitropoulos K, Martins FE et al (2022) European association of urology guidelines on urethral stricture disease part 3: management of strictures in females and transgender patients. Eur Urol Focus 8:1469–1475 PubMed DOI

Steenkamp JW, Heyns CF, de Kock ML (1997) Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol 157:98–101 PubMed DOI

Verla W, Barratt R, Chan G, Dimitropoulos K, Esperto F, Yuhong Y et al (2023) Is a course of intermittent self-dilatation with topical corticosteroids superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of intermittent self-dilatation alone? A systematic review and meta-analysis. Eur Urol Open Sci 51:95–105 PubMed DOI PMC

Redshaw JD, Broghammer JA, Smith TG 3rd, Voelzke BB, Erickson BA, McClung CD et al (2015) Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS study group. J Urol 193:587–592 PubMed DOI

Zhang K, Qi E, Zhang Y, Sa Y, Fu Q (2014) Efficacy and safety of local steroids for urethra strictures: a systematic review and meta-analysis. J Endourol 28:962–968 PubMed DOI

Elliott SP, Coutinho K, Robertson KJ, D’Anna R, Chevli K, Carrier S et al (2022) One-year results for the ROBUST III randomized controlled trial evaluating the Optilume((R)) drug-coated balloon for anterior urethral strictures. J Urol 207:866–875 PubMed DOI

Vetterlein MW, Marks P, Fisch M, Kluth LA (2022) Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists. Re: One-year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-coated Balloon for Anterior Urethral Strictures. Eur Urol 82(2):238–239 PubMed DOI

Vetterlein MW, Stahlberg J, Zumstein V, et al (2018) The Impact of Surgical Sequence on Stricture Recurrence after Anterior 1-Stage Buccal Mucosal Graft Urethroplasty: Comparative Effectiveness of Initial, Repeat and Secondary Procedures. J Urol 200(6):1308–1314 PubMed DOI

Marks P, Dahlem R, Janisch F, Klemm J, Kuhnke L, Konig F et al (2023) Mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures. BJU Int 132:444–451 PubMed DOI

Welk BK, Kodama RT (2012) The augmented nontransected anastomotic urethroplasty for the treatment of bulbar urethral strictures. Urology 79:917–921 PubMed DOI

Zumstein V, Dahlem R, Kluth LA, et al (2020) A critical outcome analysis of Asopa single-stage dorsal inlay substitution urethroplasty for penile urethral stricture. World J Urol 38(5):1283–1294 PubMed DOI

Zumstein V, Dahlem R, Maurer V, et al (2020) Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options. World J Urol 38(10):2609–2620 PubMed DOI

Campos-Juanatey F, Osman NI, Greenwell T, Martins FE, Riechardt S, Waterloos M et al (2021) European association of urology guidelines on urethral stricture disease (part 2): diagnosis, perioperative management, and follow-up in males. Eur Urol 80:201–212 PubMed DOI