Treatment for Urethral Strictures
Our team of urologic specialists treat and manage all aspects of urethral diseases and conditions, including urethral strictures. Treatment for urethral strictures can include urethral surgery or urethroplasty.
What Is a Urethroplasty?
Urethroplasty is a surgery where the urethra is reconstructed to cure problems like urethral strictures. The types of surgeries are varied and depend upon the location, cause, and length of the stricture. Most surgeries take between three to six hours to complete.
An incision is made over the area of the stricture in the penis, scrotum, or perineum (the area between the scrotum and the anus). After surgery, a urethral catheter is left in for two to four weeks depending upon the type of surgery that was performed. When patients return to clinic the bladder is filled with X-ray contrast and the catheter is gently removed.
While X-rays are being taken, the patient voids and the area of the surgery is evaluated. If the area of surgery is healed, then the catheter is left out and patients begin to void normally.
How Long Will Recovery Take?
Recovery time depends a lot on the type of surgery that was performed. Typical patients will be in the hospital overnight after surgery. As soon as they can eat, walk, and care for their catheter they can leave the hospital. It is important to limit activities after urethroplasty until adequate healing has occurred. This means no heavy lifting, strenuous exercise, or work for at least two weeks.
Generally, it is best if patients do not work while the catheter is in place, however, patients can start doing work that is not physical after 10–14 days. The catheter can be worn draining to a smaller bag that straps to the lower leg under a pair of pants. Wearing a catheter like this is unobtrusive and very manageable.
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What Is the Follow-Up After Surgery?
The follow-up after urethroplasty is very important; this is because most urethral strictures recur within the first year or two after surgery. Patients are seen every three to six months in their first year after surgery.
At the first appointment patients undergo cystoscopy of the urethra in the office and the urinary flow rate and residual urine is measured in our office. Cytoscopy is a scope exam of the urethra where a small scope is placed into the urethra from the penis, very similar to catheterization, and the area of the surgery is examined for recurrent strictures. The follow-up schedule is individualized depending upon the findings of these exams.
What Happens When Strictures Come Back After Surgery?
When strictures come back after surgery they often are thin and web-like. These strictures can cause obstruction but often can be treated internally by cutting the stricture with a scope procedure. This is not similar to the initial stricture that often has too much scarring to respond long-term to an internal cutting procedure. Some strictures are too dense and do not respond to internal cutting and the patient may need further surgery.
What Is the Success After Urethroplasty?
Different surgeries have different success rates. Generally, strictures can be resolved in 75–85 percent of cases. If strictures come back, only about one half cause symptoms. In other words if a stricture comes back, it has to be very tight to cause blockage of urinary flow, just like the original stricture.
If patients have symptoms, then an internal cutting surgery with a scope is usually tried (direct vision internal urethrotomy). If this doesn’t work, then patients may need additional surgery, which is a rare circumstance.