Pre-operative considerations for urethral stricture Urethral stricture is one of the more difficult conditions to manage in the field of urology, but there are still various treatments available that can adequately repair the urethra and give the patient a quality of life. Pre-operative examination The pre-operative examination is performed to understand the site, number, degree, length, scar tissue around the stricture and the presence of comorbidities. (1) General examination: detailed medical history, history of previous surgery and reasons for surgical failure, urethral palpation, urine culture + drug sensitivity test. (2) Special investigations: imaging including cystourethrography (required), CT 3D reconstruction and urethral magnetic resonance imaging, ultrasonography, flexible cystoscopy or urethroscopy and urinary flow rate if necessary. Preoperative preparation Urethral strictures are usually treated by urinary diversion (e.g. suprapubic cystostomy) in the acute phase with urinary obstruction and difficulty in urination, and after 3 months of urinary vacancy, surgery is performed when the inflammation and edema have subsided. Adequate preoperative assessment of the surgical pathway, especially the perineum, lower abdomen and scrotum for any abnormalities. Aggressive treatment of urethral and periurethral infections Urethral strictures result in rough and uneven urethral mucosa and poor urination, creating good conditions for urethral infection. High-pressure urination can cause bacteria in the urethral cavity to enter the periurethral tissues and cause periurethral infections. Urethral and periurethral infections are the most important cause of surgical failure. Therefore, special attention should be paid to the preoperative treatment. In addition to the active and rational use of antibacterial drugs, suprapubic cystostomy should be performed first in one of the following cases, and surgical treatment of urethral stricture should be performed after the infection is fully controlled: (1) acute or subacute periurethritis or pyelonephritis; (2) pus and blood-like discharge from the urethra, obvious pressure pain and difficulty in urination; (3) recurrent episodes of acute (3) recurrent episodes of acute pyelonephritis, acute prostatitis, orchitis or epididymitis; (4) concurrent bladder stones, diverticula, infection; (5) concurrent urethrorectal fistula or urethral skin fistula; (6) retropubic infection, residual abscess, and osteomyelitis of the pubic bone. The purpose of suprapubic cystostomy is to stop the urine above the stricture from passing through the infected urethra and to allow the urine to drain freely so that the local inflammation gradually dissipates, usually over a period of 3 months. Care of the suprapubic cystostomy should be intensified during the cystostomy period. Timing of surgery for urethral strictures (1) Ball urethral strictures: 3 months after the injury and no urethral dilatation operation within the last 1 month. (2) Membranous urethral stricture: 6 months after injury, no urethral dilatation operation within the last 1 month (3) Penile urethral stricture: no urethral dilatation operation within the last 1 month (4) Urethral dilatation bleeding: re-injury of the urethral mucosa and repeated urethral dilatation bleeding aggravating local scarring. For patients with dilatation bleeding, it is recommended to leave a urinary catheter in place for 2 weeks. In addition, forced dilation tends to form a false tract. Therefore, for urethral strictures to be operated, it is recommended that there should be no urethral dilatation operation within the last 1 month, and the time from the last operation or injury should be at least 3-6 months, and the timing of the operation should be chosen according to the local conditions.