Urethral strictures cause the urine stream to decrease and people may need to strain to urinate. Sometimes they cannot urinate at all.
Strictures are much more common in men than in women. They may occur congenitally, or as a result of trauma to the urethra. Even a severe bout of urethral inflammation caused by an infection can cause a urethral stricture. Patients with severe urethral strictures or strictures that do not respond to endoscopic management can benefit from urethral reconstruction surgery (urethroplasty).
Often times we can fix a blocked urethra endoscopically. A fiber-optic camera is used to visualize the strictured area, which can be opened by making an incision to widen the lumen. A stent can be used to stretch the urethra and keep it open. The success of endoscopic treatment depends on where the stricture is located and how long it is. When not possible or not effective, urethral reconstruction surgery is necessary.
During urethral reconstruction surgeries, whenever possible the stricture is cut and the healthy ends of the urethra are reconnected to make the urethra wider. Sometimes the diseased tissue must be replaced with healthy new tissue. In many cases, healthy tissue can be taken from the inside of the cheek, and grafted to the urethra. Because people's strictures vary in location and length, operative times for urethroplasties can vary from 3 to 6 hours.
After surgery, patients need to wear a catheter for 10-14 days, depending on the surgery performed. During their post-surgical visit, the patient’s bladder is filled with x-ray contrast and the catheter is gently removed. The patient voids while dynamic x-rays are taken to evaluate how the surgical area is healing. When totally healed, the catheter is permanently removed and patients can urinate normally.
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. When strictures recur after surgery they are usually less dense than the original stricture. Most often, they can be treated without invasive surgery, using a scope procedure to cut the stricture. In rare cases, a second urethral reconstruction surgery is necessary.