Overview

A stricture is a dense scar that occurs somewhere along the urethra. The urethra is the urinary channel that starts in the bladder, travels through the prostate, and out the penis. Strictures can occur anytime in life.  A stricture restricts the flow of urine from the bladder and can cause a variety of medical problems in the urinary tract, including inflammation or infection.

Dr. Vishal Bhalani has extensive training and experience in urethral reconstruction for stricture disease. We offer the most advanced treatment options and therapies in state-of-the-art facilities to ensure our patients get the medical care they deserve. Schedule a private consultation today.

Causes

The causes of a urethral stricture cannot always be found. Some of the common causes are:

  • Trauma, either a pelvic fracture or a blow to the perineum (the area between the scrotum and the anus)
  • Sexually transmitted infections
  • Trauma from urinary catheter placement
  • Radiation treatment for cancer
  • Scarring from urologic procedures
  • Previous surgery for hypospadias

Symptoms

  • Slowing of your urine stream, which can happen suddenly or gradually
  • Urine leakage or dribbling after urination
  • Spraying of the urine stream
  • Difficulty, straining or pain when urinating
  • Increased urge to urinate or more frequent urination
  • Blood or discharge from the penis
  • Pain with ejaculation or orgasm
  • Pain in the pelvis or lower abdomen

Diagnosis

A urethral stricture is usually diagnosed based upon either x-rays of the urethra or a cystoscope procedure. In the x-ray procedure there are two types that can be done, a retrograde urethrogram or a voiding cystourethrogram. In these x-rays contrast dye is injected via a catheter into the urethra or into the bladder and images of the urethral stricture is obtained.

These x-rays help determine the diameter of the strictures as well as its length. A cytoscopic procedure is often used as an initial diagnostic procedure. A urologist can pass a flexible scope (similar to a catheter) up the urethra from the penis and find a stricture by visualizing its opening.

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Treatments

Close follow-up and appropriate treatment of urethral strictures is very important in order to avoid the serious complications that can result like kidney failure, chronic urinary retention, or life threatening infections.

There are a variety of treatments for urethral strictures from procedures to internally cut or dilate the scar to surgery.

Internal Procedures

Often patients are treated initially with one of the internal procedures. The internal procedures are referred to as endoscopic treatments and include urethral dilation and direct vision internal urethrotomy. Dilation of the urethra involves passage of a shaped metal rod or other instrument to break open the stricture internally.

Direct vision internal urethrotomy involves cutting the stricture with a very small knife that emerges from a scope placed into the urethra. Both methods have approximately the same success.

When strictures are short, dilation or direct internal vision urethrotomy may achieve a long-term success in about one third of patients. When strictures recur after an initial endoscopic procedure additional treatment from this method is very rarely successful.

Surgical Procedures

Surgery for urethral strictures, or urethroplasty, is varied and involves many different techniques. If strictures are short and in certain portions of the urethra, the area of the urethra can be surgically removed and the healthy urethra can be reconnected. If the urethral stricture is lengthy, then other tissues need to be used to reconstruct the urethra.

One common tissue used in surgery for longer strictures is the lining of the inner cheek; this is referred to as buccal mucosa. Buccal mucosa has a tissue characteristic very similar to the native lining of the urethra and the mouth heals very well after harvest of this graft. Other options that are used for lengthy strictures include a piece of the penile skin or a hairless piece of skin from the abdomen.

Some strictures (fewer than 10%) may require staged repairs (multiple operations over a year-long period) due to their length or other complexities. These include long strictures, particularly those caused by balanitis xerotica obliterans (BXO).

What are the results?

Cure rates are usually better than 80%; however, rates decrease with more complex repairs (i.e. staged repairs).

What are the risks?

All surgeries carry some risk. There are customary risks of anesthesia and surgery, such as bleeding, infection, injury to adjacent organs and their function, and chronic pain. Specific risks for urethral surgery are possible changes in sexual function. Although uncommon, poor erections, minor penile shortening, penile curvature and changes in ejaculation may occur. Bladder control is rarely affected.

Urethroplasty

What is Urethroplasty?

Urethroplasty: Scar Tissue Repair of Urine Channel

Urethroplasty is the fixing of scar tissue in the urine channel from the bladder out the penis.  There are many surgeries possible to fix this and all work to increase the size of the urine channel to improve urine flow.

Why does scar tissue form in the urine channel?

There are many causes of this including prior injury, prior procedures such as catheter placement, prior surgery, or even sexually transmitted diseases.  A particular cause of scar formation known as Balanitis Xerotica Obliterans (BXO) can even effect a large portion of the penis both inside and out.

What problems would I have?

Anyone with a build up of scar tissue in the urine channel can have a slow urine stream or feel all the urine does not come out.  Some individuals develop a complete blockage and have no ability to urinate.  Other patients may feel pain with urination or have bladder infections.

What is done to determine if I have a blockage?

Prior to urethroplasty surgery it is important for all patients to have an x-ray test of the urethra to determine the location of the scar tissue.  Some patients may also undergo a uroflow test, urodynamics, or cystoscopy depending on the problems.

What types of repairs are available?

There are several options for fixing blockages of the urine channel.  Most scar tissue can be stretched open as a form of treatment but the scar can come back quickly with this procedure.  A camera and small scope can be used to guide a small knife to cut the scar open and usually a drainage tube is left in the penis.  In most cases this is useful for short scars or those that are new.  The longest lasting repair is urethroplasty.  In this procedure, the region of scar tissue is either removed or enlarged through a cut in the skin.  A small drainage tube (catheter) is left in place after surgery to allow the treated area to heal.

Will urethroplasty cause trouble having sex?

In general it is not likely to have trouble with sex after this surgery.  Some patients may have trouble with erections in addition to the urine channel blockage.  Both of these problems can be treated by your doctor.

Who performs a urethroplasty?

Many urologists feel confident to do the surgery but only about 10% do these surgeries often.

Does it leave a scar on the penis?

Most urethroplasty procedures are performed through the perineum, the region between the scrotum and the anus.  There are surgeries when the penis skin is used and a cut on the penis may be needed.  With care and good surgery, this rarely leads to scar tissue forming on the outside of the penis.

Does the procedure hurt?

Most people do have pain after the surgery, but the pain is usually not very bad.  Patients are given pain medication to limit the discomfort.  Some patients do not have any pain after surgery.

Atlanta Center for Urinary Control: The State’s Premier Provider of Urinary Control Treatment