A urethral stricture is the narrowing of the urethra, the tube that carries urine from the bladder out of the body. This constriction is caused by scar tissue formation within the urethral lining, which impedes normal urine flow and can lead to complications like urinary tract infections or bladder damage. Common causes include physical injury or trauma to the pelvic area, infections such as chlamydia or gonorrhea, or damage resulting from medical procedures like catheter placement. Treatment is highly individualized, depending on the stricture’s specific location, length, and the underlying cause of the scarring.
Non-Surgical and Endoscopic Interventions
Minimally invasive approaches are often considered the first step for managing shorter, less dense urethral strictures. These procedures aim to widen the narrowed segment without requiring open surgery, though they frequently provide only temporary relief. Urethral dilation involves the gradual stretching of the scar tissue using specialized instruments or balloons to mechanically force the segment open and improve urine flow.
Direct Visual Internal Urethrotomy (DVIU) uses a small scope to visually cut the scar tissue longitudinally with a specialized knife or laser, widening the channel. While less invasive, these interventions carry a high risk of recurrence, with strictures returning in approximately 65% of cases. Repeated attempts can worsen scar tissue, potentially complicating future surgical repair.
Definitive Reconstructive Surgery
For patients with longer, denser, or recurrent strictures that have failed endoscopic treatment, open surgical reconstruction, known as urethroplasty, offers the highest probability of permanent correction. Urethroplasty is a complex procedure performed by specialized surgeons to reconstruct the damaged portion of the urethra. Success rates typically range from 85% to over 90%, making it the preferred long-term solution.
The specific surgical technique used depends directly on the length of the stricture and how much urethral tissue remains healthy. For short strictures, particularly those in the bulbar urethra, Excision and Primary Anastomosis (EPA) is often the technique of choice. This involves surgically removing the entire scarred segment and then sewing the two healthy ends of the urethra back together. EPA is highly effective, with reported success rates reaching 90% or higher.
For longer strictures where removing the scarred segment would create too much tension, Substitution or Augmentation Urethroplasty is performed. This technique uses a tissue graft to patch or replace the narrowed section of the urethral wall. The most frequently utilized tissue is buccal mucosa, which is a graft harvested from the lining of the patient’s inner cheek or lip.
Buccal mucosa is well-suited for urethral reconstruction due to its durability, moisture resistance, and relatively high blood supply, which helps the graft integrate with the existing urethral tissue. The graft is placed onto the scarred area to widen the urethral channel. Long-term success rates for augmentation urethroplasty are also very high, often reported in the 85% to 90% range.
Long-Term Monitoring and Recurrence
Despite the high success rates of reconstructive surgery, a stricture recurrence remains a possibility, requiring long-term follow-up. Post-operative monitoring is structured to detect any narrowing early, typically involving regular check-ups with the surgeon.
These follow-up appointments often include uroflowmetry, which measures the speed and strength of the urine stream. A significant decrease in the flow rate can signal the return of a stricture, even if the patient is not yet experiencing symptoms.
Recurrence is more likely in the first year following any intervention, with approximately 75% of recurrences after urethroplasty occurring within the first six months. If a stricture does recur, a different treatment approach is often necessary.
Some patients, particularly those who have undergone dilation or internal urethrotomy, may be instructed in clean intermittent self-catheterization (CISC). This involves the patient periodically passing a small, lubricated catheter to mechanically maintain the patency of the repaired segment, helping to prevent the scar tissue from contracting again.