Urethral stricture treatment
The urethra’s function in males and females is to move urine outside the body. This tiny tube also has a main role in ejaculation for men. When a scar from swelling, damage, or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
What Happens under Normal Conditions?
The bladder empties through the urethra and outside of the body (called voiding). The female urethra is much shorter than the male. In males, urine must travel a longer distance from the bladder through the penis. In males, the first 1″ to 2″ of the urethra that urine moves through is called the posterior urethra. The posterior urethra includes:
- the bladder neck (the opening of the bladder)
- the prostatic urethra (the part of the urethra by the prostate)
- the membranous urethra
- a muscle called the external urinary sphincter
Strictures that occur in the first 1″ to 2″ of the urethra that urine moves through are called posterior strictures.In males, the final 9″ to 10″ of the urethra is called the anterior urethra. The anterior urethra includes:
- the bulbar urethra (under the scrotum and perineum- the area between the scrotum and anus)
- the penile urethra (along the bottom of the penis)
- the meatus (the exit at the tip of the penis)
Strictures that occur in the last 9″ to 10″ of the urethra that urine moves through are called anterior strictures.
Men are more likely to have a urethral illness or injury because of their longer urethra. For this reason, strictures are more usual in men. They are rare in women and infants. Stricture (narrowing of the urethra) can occur at any point from the bladder to the tip of the penis. This reduction restricts or slows the movement of urine. Some typical causes are:
- trauma to the urethra
- infection such as a sexually forwarded disease
- damage from medical tools
- situations that cause swelling
In most cases, no cause can be found. In adults, urethral strictures are most often due to:
- prostate surgery
- kidney stone removal
- urinary catheterization
- other surgical tools
Simply put, the urethra is like a garden pipe. When there is a kink or narrowing along with the hose, no matter how short or long, the flow is decreased. When a stricture is small sufficient to reduce urine flow, you will have symptoms. Problems with urinating, UTIs, and swelling or diseases of the prostate may happen. A severe blockage that lasts a long time can damage the kidneys.
Some signs are:
- bloody or dark urine
- blood in semen
- slow or decreased urine stream
- urine stream spraying
- pain with urinating
- abdominal pain
- urethral leaking
- UTIs in men
- swelling of the penis
- loss of bladder control
Many options are depending on the size of the blockage and how much scar tissue is involved.
- dilation – enlarging the stricture with a gradual stretching
- urethrotomy – cutting the stricture with a laser through a scope
- open surgery – surgical extraction of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty)
There are no available medicines to help treat strictures. Without treatment, you will remain to have difficulties with voiding. Urinary and/or testicular infections and stones could develop.
This is usually performed in the urologist’s clinic with local anesthesia. The stricture is using larger and larger dilators called “sounds.” A special balloon on a catheter can also stretch the tissue. But this stretching is not a cure and needs to be repeated regularly. If the stricture comes back too immediately, you may be taught how to inject a catheter from time to time to prevent it from coming back. Side effects include bleeding and infection.
This uses a special scope that is passed along the urethra until the stricture is found. A knife blade or laser at the end of the cystoscope is applied to cut the stricture and build a gap. A catheter may be fixed into the urethra to hold the gap open and let it heal. The recommended time to leave a catheter tube draining is based on the length of the stricture.
Many reconstructive methods have been used to treat strictures, and some involve 1 or 2 operations. In all cases, the choice of repair is based on the place and length of the stricture and how dangerous it is. No single repair is right for all cases. The 2 main kinds are anastomotic urethroplasty and substitution urethroplasty. Anastomotic Urethroplasty
This process is normally reserved for short urethral strictures. In this situation, a cut is created between the scrotum and rectum. The urethra can then be reconnected after eliminating the stricture. This is normally conducted as an outpatient method or with a short clinic stay. A short, soft catheter is left in the penis for 10 to 21 days. It is then divided after an X-ray is taken to make sure the repair has cured.
Substitution Urethroplasty When the stricture is long, tissue can be carried to replace the section that had the stricture. In complicated cases, replacement repairs may need to be done in stages. These patches should be done by a urologist experienced with these surgeries. Overall the success rates are very good. The 3 kinds of substitution procedures are:
- Free graft
- Skin flap
This method replaces or enlarges a section of the urethra using your tissue. The tissue may be skin (taken from the shaft of the penis) or, more often, buccal mucosa (taken from inside the cheek). After the operation, you may require a short hospital stay and use a catheter for 2 or 3 weeks.
With this surgery, flaps of skin are rotated from the penis to create a new section of the urethra. This is needed when a graft needs to belong, and the stricture is severe. These systems are complex and should be done by a surgeon with plastic surgery experience. After the operation, you may need a short clinic stay and use a catheter for 2 or 3 weeks.
This method is used when local tissue will not run for a free graft or a skin flap.
- First stage – The underside of the urethra is opened, which displays the full length of the stricture. A graft is secured to the opened urethra. The graft heals and matures for 3 months to a year. During that time, you will urinate through a new opening behind the stricture.
- Second stage – Several months after the graft around the urethra has healed and is soft and flexible, the graft is formed into a tube.