A urethral stricture is a scar or narrowing of the urethra that may make it difficult for you to urinate. Symptoms may include a slow or weak urinary stream, frequent urination, an urgent need to urinate and urinary tract infection
There are many causes of a urethral stricture. Common causes range from perineal trauma (i.e. straddle injury), pelvic trauma, sexually transmitted diseases, urethral trauma, radiation treatments and some skin disorders.
A urethral stricture may be detected by an X-ray study or by a cystoscopy. The best test for diagnosis (in most cases) is an X-ray study called a retrograde urethrogram. During this test, a very small catheter is inserted into the tip of the penis and contrast is gently used to fill the urethra. This test allows us to see the location, length and severity of the urethral stricture.
There are several broad options for managing a urethral stricture. Understanding the location, length and severity allows us to better tailor the treatment options to each individual patient.
Urethral Dilation: Using sequentially bigger tubes, the stricture (scar) is stretched using a cystoscope. It will not cure most strictures but it will temporarily make your symptoms better. This is an outpatient procedure and you will usually have a catheter for 1 week.
Urethrotomy: This is a very similar procedure to a urethral dilation.. Instead of using tubes, a small knife is used that can pass through the cystoscope to cut the stricture open. It will not cure most strictures but it will temporarily make your symptoms better. This is an outpatient procedure and you will usually have a catheter for 1 week.
Urethroplasty: This involves open surgical correction of the stricture. Although this is the most invasive option, cure rates are vastly better than the previous options. Cure rates can be as high as >90% although more complex repairs have lower success rates.
Diversion: Options for diversions include a perineal urethrostomy in which we make a new urethral opening usually behind the scrotum. Your ability to control your urination should remain unchanged. The main difference is that you will need to sit to urinate. Other diversion options involve re-routing the urine away from your urethra.
The type of repair offered to you will depend on several things including: your goals, your overall health, the location, length and severity of the stricture. A general anesthetic is required for these procedures. The incision is over the urethra (location depends on the location of the stricture). You will usually spend one night in the hospital after surgery.
One Stage Repairs
Primary Excision and Anastomosis: The entire scar can be excised and the urethra reconnected. A catheter is needed for 2 weeks after surgery.
Augmented Anastomotic Repair: If the stricture is too long, we cannot remove all of it or we may need a graft to help the repair. The best graft is often the lining of the cheek (buccal mucosa). If a graft is needed, it does add some risk to the procedure, although minor. A catheter is needed for 3 weeks after surgery.
Graft Only Repair: For some scars, we cannot remove the stricture. Rather, we open the scar and lay a new “roof” using a graft (buccal mucosa). A catheter is needed for 3 weeks after surgery.
Two Stage Repairs
Less than 10% of strictures may require a staged repair (multiple operations over a one year period). These include long strictures, particularly those caused by a skin condition Lichen Sclerosis (aka BXO)
There are the customary risks of anesthesia and surgery (bleeding, infection, injury to adjacent organs and their functions and chronic pain). Scars can be but are rarely unsightly. Specific risks to sexual function are uncommon, but poor erections, minor penile shortening, penile curvature and changes in ejaculation may occur. Bladder control is rarely affected.
After any procedure, we will see you back to remove the catheter. After that, we will closely monitor your urine flow and ask that you do the same at home.