Urethral Stricture Surgeries

Causes of Urethral Strictures

• Injury or Trauma: Pelvic fractures or blunt trauma to the urethra.
• Infections: Untreated sexually transmitted infections (e.g., gonorrhea) or repeated urinary tract infections (UTIs).
• Surgical Procedures: Previous catheterization, prostate surgeries, or radiation therapy.
• Congenital Conditions: Present at birth due to abnormal urethral development.

Symptoms of Urethral Strictures

• Reduced or weakened urine flow.
• Difficulty starting urination (hesitancy).
• Painful urination or ejaculation.
• Frequent UTIs or bladder infections.
• Urinary retention or incomplete bladder emptying.

Types of Urethral Stricture Surgeries

1. Dilation

• Procedure:
  • Gradual stretching of the urethra using dilators of increasing sizes.
  • Performed under local or general anesthesia.
• Best For: Mild strictures.
• Limitations: Temporary relief; strictures may recur.

2. Internal Urethrotomy

• Procedure:
  • A cystoscope is inserted into the urethra, and a small incision is made in the scar tissue using a knife or laser.
  • Restores urine flow by widening the narrowed segment.
• Best For: Short strictures.
• Recovery: Quick; most patients resume normal activities within a week.

3. Urethroplasty

• Procedure:
  • Open surgery to remove or reconstruct the narrowed portion of the urethra.
  • Tissue grafts (from the mouth or inner cheek) may be used for reconstruction.
• Best For: Long, complex, or recurrent strictures.
• Recovery: Requires a hospital stay and several weeks of rest.

4. Stent Placement

• Procedure:
  • A permanent stent is placed in the urethra to keep it open.
• Best For: Cases where other methods are unsuitable.
• Limitations: Potential for discomfort or complications over time.

Post-Surgical Care

• Catheter Use: A temporary catheter may be placed to allow the urethra to heal.
• Hydration: Drink plenty of water to flush the urinary system.
• Avoid Strain: No heavy lifting or strenuous activity for a few weeks.
• Medications: Antibiotics to prevent infections and pain relievers as needed.
• Follow-Up Visits: Regular monitoring to ensure successful healing and check for recurrence.

Complications (Rare):

• Infection or bleeding.
• Recurrence of the stricture.
• Urethral injury or scarring.
• Urinary incontinence or difficulty with sexual function (rare in skilled hands).

Outcomes of Urethral Stricture Surgery

• Internal Urethrotomy: Success rates of 30–60%, with recurrence more common in long or complex strictures.
• Urethroplasty: High success rate (80–95%), with durable long-term outcomes.

Conclusion:

Urethral stricture surgeries offer effective relief from symptoms, restoring normal urinary flow and preventing complications. The choice of procedure depends on the severity, length, and recurrence of the stricture, as well as patient-specific factors. Early intervention and proper post-operative care are critical for achieving the best outcomes.