title: Endoscopic incision of short (<3 cm) urethral strictures after phallic reconstruction.
abstract: BACKGROUND
  Urethral stricture formation is a frequent complication after phallic reconstruction, but little is known about the treatment. Endoscopic cold-knife incision has long been applied for short urethral strictures. Can this treatment be used for strictures in the phalloplasty patients as well?
  
  
  METHODS
  Thirty-two endoscopic urethrotomies were done in 22 patients with a phalloplasty. Only noncomplicated strictures shorter than 3 cm were considered appropriate for endoscopic incision. The stricture was treated by a cold-knife incision. The urethral catheter was maintained for at least 2 weeks. Follow-up was done every 3 months during the first year and annually thereafter. Comparing failures with successful cases, prognostic factors for success are assessed.
  
  
  RESULTS
  Median follow-up is 51 months (range, 8-95 months). In 14 patients, no previous intervention was done. Mean stricture length is 1 cm (range, 0.5-2.5 cm). Endoscopic incision was successful in 14/32 cases (43.8%). First incision was successful in 10/22 cases (45.5%), a second incision was successful in 4/7 cases (57.1%), but three or more incisions were never successful (0/3). The only significant difference between failures and successful cases is the interval between phalloplasty and endoscopic incision (32 vs. 9.9 months; p = 0.00008).
  
  
  CONCLUSIONS
  Endoscopic incision for short (<3 cm) urethral strictures after phallic reconstruction can solve the problem in about half of the cases. Three or more incisions seem to be useless. Endoscopic incision is significantly better when performed with a long-term interval after phalloplasty, indicating that a well-healed phallic urethra is more prone to a successful endoscopic incision.
authors: Department of Urology, Ghent University Hospital, Ghent, Belgium. lumennicolaas@hotmail.com
authors: Nicolaas
authors: N
authors: Lumen
authors: Willem
authors: W
authors: Oosterlinck
authors: Karel
authors: K
authors: Decaestecker
authors: Stan
authors: S
authors: Monstrey
authors: Piet
authors: P
authors: Hoebeke
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D017211:Treatment Failure; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000209:etiology* / Q000601:surgery*