Male urethra

Hypospadias

• Indications for surgery:
  • Improve sexual function
  • Correct problems with urinary stream
  • Cosmetic reasons
• Avoid circumcision before the hypospadias has been repaired

Epispadias

• Urethral opening on dorsum of the penis

Urethral stricture

• Aetiology
  • Inflammatory
    • Urethritis - most commonly in bulbar urethra
    • Balanitis xerotica obliterans - fibrosis of the foreskin resulting in phimosis
  • Traumatic
    • Bulbar urethral injury
    • Pelvic fracture urethral disruption injury
  • Iatrogenic
    • Secondary to urethral instrumentation including catheterisation and TURP
      • Tends to happen either where urethra bends or where it narrows
    • Secondary to radical prostatectomy
    • Secondary to radiotherapy for prostate cancer
  • Idiopathic
• Presentation
  • Young man with poor stream, post-micturition dribbling
• Complications
  • Retention - may need SPC
• Treatment
  • Dilation is reserved for elderly men with short strictures that recur infrequently
  • Short strictures with a clear traumatic history - urethroplasty - cure rates >90%
  • All other strictures - internal urethrotomy (the stricture is cut using a knife passed through the sheath of a rigid urethroscope, usually cut at the 12 o'clock position)
  • If recurs after that initial procedure, consider something more complex

Urethral tumour

• Rare
• Consider if bloody urethral discharge
• SCC can develop in a stricture