Urethral Strictures: Symptoms, Treatment Options, Cases

This video is about a urethral stricture. Urethral stricture presents various degrees of narrowing or complete obliteration of urethral channel. Any part of urethra may be affected.
Urethral strictures can be caused by trauma, infection, dermatologic disease, congenital anomaly of the penis, iatrogenic treatment.
Patient usually has difficulty to empty the bladder, painful urination, weak urine stream, spraying of urine, dribbling, urinary incontinence, urinary tract infections and decreased ejaculation force. Sometimes symptoms may be absent.

The treatment options for urethral stenosis are: dilatation, endoscopic incision (urethrotomy) and surgical reconstruction.
Dilatation procedure presents stretching of the stricture using progressively larger metal dilators. Dilatation is rarely a cure and needs to be periodically repeated. Pain, bleeding, infection and creating of "false passage" are the main problems associated with dilation procedures.

Urethrotomy procedure is an incising of the narrowed segment of urethra by knife blade or laser inserted by endoscopic instrument. It can be successful for very short urethral strictures in specific part of the urethra. Urethrotomy, as well as dilatation, can cause excessive damage of the urethral tissue and actually aggravate urethral stricture.

Open surgical reconstruction of urethra is a contemporary treatment of urethral strictures. Urethral channel can be reconstructed or replaced by one or two stage procedures.
For short urethral strictures located in posterior part of urethra, anastomotic repair is used. It includes removal of scarred urethral segment and reattachment of urethral stumps. Narrowed urethral segment can be augmented by buccal mucosa graft or penile skin flap. Completely obliterated longer urethral segment can be replaced by combined buccal mucosa graft and penile skin flap as one stage procedure.

Two-stage urethral reconstruction includes placement of buccal mucosa graft as first stage procedure and tubularization into neourethra as second stage six months later.
We use the best silicon urethral catheters for urethral modeling and stenting. Catheters are left for 7 to 14 days, depending of the type of urethral stricture and type of procedure. Suprapubic urinary tube can be used to enable better and faster healing of the reconstructed urethra. If buccal mucosa graft is harvested, donor site defect is usually closed directly and it heals within 3-5 days.

All stated surgical procedures are performed in our center with high success rate. The long-term follow up of these patients, constant comparison of our results with the results from different medical centers around the world as well as exchange of knowledge and experience allows us to establish the best surgical option for our patients.