To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.

Female urethral strictures are rare. Guidelines on how to diagnose and treat these strictures are lacking. At present, only expert opinion is available to guide clinical practice. Once the diagnosis is suspected based on obstructive voiding symptoms and uroflowmetry, most clinicians will use in addition video-urodynamics (including urethrography), urethral calibration and cystourethroscopy for confirmation of the diagnosis. Clinical inspection and gynaecological examination are also important. Urethral dilation is usually the first-line treatment despite the lack of long-term success. Female urethroplasty is associated with higher success rates. A multitude of techniques are described but not one technique has shown superiority above another. This narrative review aims to provide a clinical guide for diagnosis and treatment to the urologist motivated to perform female urethroplasty.

Background: Until recently, all available erectile devices were manufactured in accordance with the anatomy of a native penis and led to high explantation rates when implanted in the neophallus.Aim: The aim of this study was to investigate surgical outcomes after implantation of the ZSI 475 FTM in the neophallus; this is the first erectile device specifically manufactured for implantation after phalloplasty.Methods: This is a prospective observational study of patients undergoing implantation of the ZSI 475 FTM in the neophallus at a tertiary referral center since September 2017. Patients with a follow-up < 3 months were excluded from this analysis.Outcomes: Intraoperative and postoperative complications were analyzed with descriptive statistics and explantation-free survival was assessed using a Kaplan-Meier survival analysis.RESULTS: In total, 57 patients were included with a median (IQR) follow-up of 16 (10-21) months. No intraoperative complications occurred. Postoperative complications were seen in 18 of 57 (32%) patients and included cylinder protrusion (1/57, 1.8%), infection (8/57, 14%), malpositioning (4/57, 7.0%), mechanical failure (4/57, 7.0%), and urinary retention (1/57, 1.8%). A total of 13 of 57 (23%) devices were explanted which corresponds with an estimated explantation-free survival rate (SD) of 84% (4.9), 80% (5.6), and 80% (5.6) after, respectively, 6, 12, and 18 months of follow-up.Clinical implications: By better addressing the specific needs after phalloplasty, this innovative erectile device might lead to improved cylinder protrusion, malpositioning, and mechanical failure rates, but device infection remains common.Strengths & limitations: This is the largest study on this topic to date and the first to report prospective data. Main limitations involve the relatively small sample size and the limited follow-up.CONCLUSION: Short-term cylinder protrusion, malpositioning, and mechanical failure rates are encouraging, although device infection remains a common problem. These complications resulted in a device explantation rate of 23%.

Background: Since the recommendation to perform excision and primary anastomosis (EPA) for isolated, short, anastomotic strictures in transmen, there have been no further reports about its results. This study aims to provide an updated and extended report about the results of EPA for the aforementioned indication. Methods: Since 2002, data of all transmen in whom an EPA urethroplasty has been performed at Ghent University Hospital were collected in a database. Exclusion criteria for this analysis were age 3.0 cm. Postoperative complications were analyzed with descriptive statistics. Failure-free survival (FFS) was analyzed with Kaplan–Meier statistics. Need for further urethral manipulation was used as definition for failure. Potential predictors for failure were entered in a univariate Cox regression analysis. Results: In total, 44 patients were included with a median (interquartile range) follow-up of 40 months (7–125 months). Complications after EPA urethroplasty were present in 12 (27%) of the patients and mainly involved low-grade complications (11/44, 25%). After 1, 2, and 5 years, the estimated FFS rate (SD) was 61% (7.8), 61% (7.8), and 47% (9.1). Stricture length (hazard ratio [HR], 2.11; P = 0.03), prior urethroplasty (HR, 3.53; P = 0.008), and extravasation at first voiding cystourethrography (HR, 3.00; P = 0.047) were identified as predictors for failure. Conclusions: EPA for an isolated, short, anastomotic stricture in transmen is associated with low complication rates, but high failure rates. After 5 years, the estimated FFS rate is 47%. Stricture length, prior urethroplasty, and extravasation at first voiding cystourethrography are predictors for failure.