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Guerra et al. Plast Aesthet Res 2022;9:42 Plastic and
DOI: 10.20517/2347-9264.2021.136
Aesthetic Research

Review Open Access

Urethroplasty in a post irradiation urethral stricture -
a review

1,2
2
1,3
Carlos Guerra , Sergio Davila , Slavica Pušica , Predrag Aleksic 3
1
Department of Urology, Belgrade Center for Genitourinary Reconstructive Surgery, Belgrade 11000, Serbia.
2
Department of Urology, Hospital Universitario “Dr. José Eleuterio González”, Monterrey, Nuevo Leon 64460, Mexico.
3
Department of Urology, Medical Military Academy, Belgrade 11000, Serbia.
Correspondence to: Dr. Carlos Guerra, Department of Urology, Hospital Universitario “Dr. José Eleuterio González”, Avenida
Franscico I Maderoy Gonzalitos, Mitras Sur, Monterrey, Nuevo Leon 64460, Mexico. E-mail: dr.carlos.guerra@outlook.com
How to cite this article: Guerra C, Davila S, Pušica S, Aleksic P. Urethroplasty in a post irradiation urethral stricture - a review.
Plast Aesthet Res 2022;9:42. https://dx.doi.org/10.20517/2347-9264.2021.136

Received: 27 Dec 2021 First Decision: 18 Apr 2022 Revised: 9 May 2022 Accepted: 27 May 2022 Published: 21 Jun 2022
Academic Editors: Stan Monstrey, M.L. Djordjevic Copy Editor: Peng-Juan Wen Production Editor: Peng-Juan Wen

Abstract
Radiotherapy-induced urethral strictures (RIUS) decrease quality of life and present a great challenge for surgical
reconstruction, especially due to proximal location, compromised vascular supply, and poor wound healing. It is
unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation. We
review the pathophysiology, diagnostic workup, and disease-specific aspects of RIUS. Furthermore, we discuss
several management alternatives such as excision and primary anastomosis, as well as techniques for open
reconstruction with flaps. The most extensive techniques in the treatment of strictures include, for example, those
using gracilis muscle flaps, as they can involve periurethral tissue to provide sufficient vascularity for excellent
post-surgery urethral healing. In brief, RIUS represent a significant challenge. In carefully chosen patients,
urethroplasty should be considered as a feasible and durable treatment. However, medical practitioners should
always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties
without a radiation background.

Keywords: Urethra, stricture, radiotherapy, urethroplasty, buccal mucosa graft, gracilis muscle flap, stricture

INTRODUCTION
Radiotherapy (RT) is a popular and successful method for treating pelvic malignancies. Half of the patients

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