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The underlying causes of anterior urethral stricture relate to urethral fibrosis from sexually transmitted infection, with posterior urethral disruption secondary to pelvic trauma being an equally common cause of USD in many countries in sub\u2010Saharan Africa. Anterior urethral strictures are often long, and multifocal, and bulbo\u2010prostatic disruptions are usually due to relatively low\u2010velocity pelvic trauma. The management options available in resource\u2010poor settings are often severely limited by the individual's ability to pay for care, the availability of a specialist surgeon and, importantly, a shortage of functioning endoscopic equipment for less\u2010invasive treatments. Consequently, reconstructive surgery is often regarded by the patient, and surgeon, as the most cost\u2010effective and, therefore, primary means of treating a urethral stricture once urethral dilatation has failed. Regional anaesthetic techniques have limited the adoption of free\u2010graft augmentation as an alternative to pedicled flaps of locally available skin for reconstruction, whilst an inability to provide tension\u2010free bulbo\u2010prostatic anastomoses has negatively impacted the outcome from the treatment of pelvic fracture disruption injuries in much of sub\u2010Saharan Africa. However, Urolink has found that local surgeons can be taught sustainable skills required for successful complex urethroplasty when supported by longitudinal mentorship in the management of difficult clinical issues. Evidence\u2010based practice is known to improve the standard of care in specific conditions in high\u2010income countries, including the management of male USD. However, guidelines developed in high\u2010income countries are not necessarily appropriate for stricture management in less well\u2010resourced healthcare environments but could be adapted to help improve the delivery of stricture care for men in low\u2010 or low\u2013middle income countries.<\/jats:p>","DOI":"10.1111\/bju.15831","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T02:24:31Z","timestamp":1655778271000},"page":"157-165","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Male urethral stricture disease: why management guidelines are challenging in low\u2010income countries"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5359-1877","authenticated-orcid":false,"given":"Stephen R.","family":"Payne","sequence":"first","affiliation":[{"name":"Urolink British Association of Urological Surgeons  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Anderson","sequence":"additional","affiliation":[{"name":"Urolink British Association of Urological Surgeons  London UK"},{"name":"Dudley Group NHS Foundation Trust  Dudley UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nenad","family":"Spasojevi\u0107","sequence":"additional","affiliation":[{"name":"University Teaching Hospital  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilaneh L.","family":"Demilow","sequence":"additional","affiliation":[{"name":"Hawassa University Comprehensive Specialized Hospital  Hawassa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getaneh","family":"Teferi","sequence":"additional","affiliation":[{"name":"Hawassa University Comprehensive Specialized Hospital  Hawassa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dickerson","sequence":"additional","affiliation":[{"name":"Urolink British Association of Urological Surgeons  London UK"},{"name":"Weston Area Health NHS Trust  Weston\u2010super\u2010Mare UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"e_1_2_4_2_1","volume-title":"Male\u2010specific Diseases. 198 \u2013 201. in Global Surgery and Public Health: A New Paradigm","author":"DeVries CR","year":"2012"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2010.09261.x"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15628"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11884-013-0185-8"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-019-02819-2"},{"key":"e_1_2_4_7_1","unstructured":"WHO.Global health estimates: Leading causes of DALYs. 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