Definitive solutions for urethral stricture

Urethral stricture is an entity that consists in the narrowing of the lumen of the tube that conducts urine from the bladder to the tip of the penis. This process causes difficulty in urinating, and depending on its severity, the symptoms will be more or less pronounced.

Why does urethral stricture occur?

The incidence of this pathology is estimated between 800 to 1000 out of every 100,000 individuals. Its most frequent etiology is inflammation produced in most cases by infection or trauma. The most frequent cause in our field is previous manipulation of the urethra (previous transurethral surgery, catheterization, etc.). In children, the most prevalent causes are congenital.

Symptoms of urinary obstruction due to urethral strictures

The clinical manifestations are difficulty urinating and those derived from urinary obstruction such as: acute urinary retention, infection of the prostate, genitals, urinary tract, stone formation and renal insufficiency. The most typical manifestation is voiding difficulty which, as the stricture progresses, is exacerbated to the point of causing in some cases urinary retention, forcing the placement of a supra pubic catheter.

Surgery, solution to urethral stricture

The treatment of urethral stricture is surgical. The objectives of the treatment are:

  • Resolve the stricture
  • To reduce the possibility of recurrence as much as possible.
  • To be as atraumatic as possible

Depending on the etiology, the length of the stricture and whether it is a first treatment or a consecutive one (due to recurrence of the stricture), the urologist specialist will propose a specific technique.

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Types of intervention for urethral stricture

  • Internal urethrotomy: endoscopic treatment that splits the stricture from the inside. It is only indicated in short strictures (urethral ring). It has a non-negligible recurrence rate. It is a simple technique with a rapid recovery.
  • Term-Terminal Urethroplasty: it consists of sectioning the urethral lesion and suturing the healthy ends. Its application is determined by stenosis of less than 3-4 cm in length. It has a lower rate of restenosis and can only be used in the bulbar urethra (the one located outside the penis).
  • Complex Urethroplasty (free buccal mucosa graft, cutaneous flap): consists of splitting the stricture and joining it with tissue taken from another part of the patient’s body. The most commonly used tissue is buccal mucosa extracted from the inner part of the cheek. In this way the diameter of the duct is increased and the narrowing is solved. It is a more complex procedure, which allows the treatment of long stenosis. Recovery and hospital stay are longer.

There are multiple variants of the techniques described above to suit the particularity of each patient. They must be thoroughly analyzed with appropriate imaging techniques and clear treatment objectives must be established.