We read the article by Mathur et al.  with interest, in which the authors advocate the use of preputial flap urethroplasty for long-segment urethral stricture. Some points in this article need clarification. The authors mention that the strictures were complex in nature; however, they fail to mention the criteria used for this classification. The sites of stricture also need explanation. How many strictures were extending into the membranous region and what was their aetiology?
Also, it is not clear from the manuscript if urethral ultrasonography was performed only at 3 months or even later. The authors mention that the postoperative median diameter of the urethral lumen on ultrasonography was 4.8 mm. As urethral ultrasonography is not routinely performed, it would have been useful if the authors had highlighted how the urethral lumen size was calculated. Were the lumen diameters calculated at several points and then a mean value obtained in each patient? What is the normal lumen size on ultrasonography?
In the discussion, the authors have highlighted the role of gutka and mention that its use is fairly common in their state; however, they have not highlighted the role of gutka use in their results. The authors found that smoking adversely affected the results of urethroplasty in their study. Could the use of gutka also affect the outcome?
Apul Goel and Manmeet Singh
Department of Urology, King George Medical University, Lucknow, India
- Mathur RK, Nagar M, Mathur R, Khan F, Deshmukh C, Guru N. Single-stage preputial skin flap urethroplasty for long-segment urethral stricture: evaluation and determinants of success. BJU Int, doi:10.1111/bju.12361.