I followed this case some years ago for 2 or 3 years, and I haven't elucidated the problem. I was going through my video archive and I found it, I was hoping that someone can recognize it.

The different answers that I have received till now:

1- infection of Littre glands.

2- Malakoplakia

3- Metallic stent reaction

4- or resorbable stent reaction

5- foreign body in urethra....

Dear Mohammed, it seems to be a recent sequel of scraping trauma to the urethral mucosa by some instrument manipulation that was made a few days before your internal urethrotomy.

Dear Manouchehr,

Thank you for your answer. I thought some thing like that in the begignning. However, the patient had just a try of urethral catheterization, which was impossible, then a percutaneous cystostomy catheter was placed.

Also, in the follow up the same lesion was present at urethroscopy.

Dear Mohammed,

That just might be something akin to squamous metaplasia -it is ocassionally seen with BXO. And BXO might be the initial /underlying mechanism of his stricture too.

Dear John, Thank you for your comment, is it possible even with no penile location, and the first 4 or 5 cm of urethra are normal. Also, can it explain the neat circumferential architecture of the lesions.

In all the different answers that I have received till now, there is only the reaction to a wall stent that can explain the neat circumferential architecture of the lesion. However I don't think it is the case, the patient is positive he hadn't had any urologic procedure before, and the wall stents or similar are not common in my country.

All the other diagnosis might be possible however they don't explain the distribution and location of the lesions.

1- infection of Littre glands.

2- Malakoplakia

3- Metallic stent reaction

4- or resorbable stent reaction

5- foreign body in urethra....

6- tuberculosis

7- urethral manipulations,

8- parasites: bilharziosis (schistosomiasis) or other parasite

9- amyloidosis

10- reaction to a urethral stent

Another suggestion by a colleague, is Leukoplakia of the urethra, I don't have any experience. I think they are white plaques, but in this case there are granulations. Also, can it explain the architecture of the lesions. Have you seen a similar case?

It could have been some sort of self instrumentation by the patient that led to this bizzare endoscopic appearance,

Thank you your comments, the careful asking of the patient didn't found any history of self-manipulation or previous endourologic procedures.

This is not an unusual presentation in a young man. He must have had a straddle injury when growing up as a kid, either biking or maybe falling astride on a bar, and he just does not recall the event. He had the stricture for so long, and that is why his bladder has so many trabeculae, cellules and diverticula. The ring is typical for a straddle injury at the proximal bulbar area, and the hydrostatic pressure due to turbulent flow created the metaplasia/chronic inflammation on the mucosa. He needs urethral reconstruction  

Dear Ramon

Your theory is an attractive one, but your proposed mechanism for these sequential regular and active lesions under the effect of  urine  turbulence does not sound a logical reason, Moreover the turbulent flow is a random phenomena without any regular shape to make such a regular effect on urethral mucosa, thus the physical nature of a turbulent flow does not match with the observed lesions in urethroscopy, other findings on cystoscopy coincides the usual pathophysiologic appearance of bladder compensation in response to any severe urethral strictures.

Dear Dr Ramon,

Thank you for your comment,  I agree with Dr Manouchehr, If your appealing theory is correct then these lesions will be a common findings in urethral strictures.

Have you seen a similar lesion with the same pattern?

In all the different answers that I have received till now, there is only the reaction to a wall stent that can explain the neat circumferential architecture of the lesion. However I don't think it is the case, the patient is positive he hadn't had any urologic procedure before, and the wall stents or similar are not common in my country.

All the other diagnosis might be possible however they don't explain the distribution and location of the lesions.

1- infection of Littre glands.

2- Malakoplakia

3- Metallic stent reaction

4- or resorbable stent reaction

5- foreign body in urethra....and self-manipulation.

6- tuberculosis

7- urethral manipulations,

8- parasites: bilharziosis (schistosomiasis) or other parasite

9- amyloidosis

10- reaction to a urethral stent

11- autoimmune conditions

12- vestigial reproductive tissue

13- metaplasia

14- leukoplakia

15- xantogranulomata

16- condyloma

17- Corynebacterium D2 urethritis