Urethral stricture surgery is a procedure to treat a narrowing of the urethra, which can cause urinary difficulty. The surgery aims to remove or dilate the stricture, restoring normal urine flow. Techniques vary, including urethroplasty where the narrowed segment is removed or enlarged, and dilation or stenting to stretch the stricture. The choice of procedure depends on the stricture’s length and location.
Urethral stricture surgery is necessary for individuals with a narrowed urethra, which can cause urinary difficulties, infections, and damage to the kidneys. The goal is to restore normal urine flow. Methods include urethroplasty, where the narrowed part is removed or reconstructed, and dilation or stenting, where the stricture is stretched or supported open. The choice of procedure depends on the stricture’s severity, location, and the patient’s overall health, aiming to provide lasting relief and improve quality of life.
Urethroplasty is a surgical procedure to repair a urethral stricture, which is a narrowing of the urethra. It involves reconstructing the narrowed segment of the urethra to restore normal urine flow. The surgery can be performed using various techniques, depending on the stricture’s location and length, including removing the scarred section and connecting the healthy ends, or using tissue grafts to enlarge the narrow part. This procedure aims to provide a long-term solution for urethral strictures.
Treatments
Urethral dilation
This refers to a procedure where the urethral stricture is slowly stretched so that the circumference of the stricture is larger.
The procedure involves the doctor inserting a tiny wire through the urethra into the bladder. Dilators (thin rods) of progressively larger sizes are then passed over the wire to gradually expand the size of the urethral stricture.
A urethral dilation is typically performed under local, regional or general anaesthesia and takes only a few minutes. However, it is important to note that the procedure may need to be repeated from time to time as strictures may recur. You may need to perform self-calibration of the urethra for a period of time to reduce the risk of stricture recurrence. If the stricture recurs, repeat dilation is not usually effective in providing long-term relief; hence, surgery is recommended.
Optical urethrotomy / Otis urethrotomy
Also used to treat urethral stricture; the procedure involves incising the stricture under direct visualisation endoscopically using a specialised tool called a urethrotome. Think of it as a rigid thin telescope. It is then inserted into the urethra to examine the narrowing before an incision is made. To further assess your condition, the scope may also be inserted all the way into the bladder.
The procedure is done under regional or general anaesthesia and usually takes between 15 – 30 minutes.
As a general guide, the method is typically used for the first episode of urethral stricture. It is most effective in strictures that are relatively short in length and are not overly dense. It may also be used for recurrent and slightly more complex urethral strictures. Success rates may differ on a case-by-case basis.
Meatotomy & Meatoplasty
Meatotomy is a procedure to surgically open the hole of the penis with no stitching. Meatoplasty, on the other hand, involves surgically opening the hole of the penis and stitching the edges together.
These 2 procedures are done when the hole/opening of the penis, called the urethral meatus, is too small, a condition known as meatal stenosis. The condition affects around 10% of males.
This condition makes it difficult for the patient to urinate. Some symptoms include feeling pain while urinating, needing to urinate often, and spraying/abnormal urine stream. If left untreated, urethral meatus could cause urinary tract infection and, in severe cases, kidney impairment.
Depending on the severity, the procedure could involve the use of a topical anaesthetic or general anaesthetic. Once the anaesthetic takes effect, the meatus will be cut or reconstructed to make the opening bigger.
During the recovery process, it is normal to experience slight pain or burning sensations when urinating. This should subside fairly quickly.
Urethroplasty
The procedure is done when there is a significant amount of scar tissue within the urethra. This could be due to an injury or prior procedures, including urethral trauma, prior surgery, or STDs.
If your doctor suspects that there are strictures in your urethra, you will be sent for a retrograde urethrogram (a type of X-ray) or cystoscopy to confirm the location and length of the stricture.
The incision depends on the site of the stricture. Most commonly, it is done on the perineum (the area between the scrotum and anus), but it can also be done on the underside of the penis or in the scrotum.
In simpler cases, the procedure involves cutting a part of the urethra with the scar tissue and connecting the two ends. In more complicated cases where a longer length of urethra is affected, tissue grafts may be required, which can be taken from the mouth.
The incision will then be closed, and a drain will be placed and kept for a few days. A catheter will also be placed to allow the urine to leave your body while the area heals. Typically, absorbable sutures are used. These are stitches that will be absorbed by your body so you won’t have to go back to your doctor to have them removed.
