Urethral Stricture Disease
What is urethral stricture disease?
A urethral stricture is a narrowing in the urethra due to scar tissue, which blocks the normal flow of urine from the bladder. Signs and symptoms include a decreased stream, difficulty or straining with urination, incomplete bladder emptying, pain with urination, and urinary tract infection. Causes include sexually transmitted infections, trauma to the urethra/perineum/pelvis, prior urethral instrumentation/surgery/catheter, radiation (typically for prostate cancer), and lichen sclerosus, a chronic, inflammatory condition that involves the genital skin and urethra. Often times, the urethral stricture has an unknown cause.
Dr. Cheng did a fellowship in reconstructive urology, which has a special focus on urethroplasty surgery.
Diagnosis and Treatment Options
A urethral stricture is usually diagnosed using a special x-ray called a retrograde urethrogram or voiding cystourethrogram. A cystoscopy (small camera placed through the urethra) is often used to visualize the stricture.
If the stricture is short, a minimally-invasive procedure can be performed in the operating room under anesthesia. With both methods, approximately 1/3 of patients will have long-term success. If the procedure fails, the next step is open surgery.
A urethral dilation can be performed by passing special dilators through the urethra to break open the scar.
A direct vision internal urethrotomy is when a cystoscope (camera) is placed through the urethra and a small knife is used to cut open the scar.
Urethroplasty is the most definitive and successful treatment option for urethral stricture. Urethroplasties are performed under general anesthesia in the operating room and usually take approximately 2-4 hours. The incision can be in the penis or perineum.
Excision and primary anastomosis: For short strictures, the area of scar tissue is cut out and the healthy urethra is reconnected.
Buccal mucosa graft urethroplasty: For longer strictures, the scarred urethra is cut open and tissue from the lining of the inner cheek (buccal mucosa) is used to repair the urethra.
After the surgery, patients can go home (if performed at RMA) or stay in the hospital overnight (Morristown Medical Center). A urethral catheter is left in place for 2-4 weeks. A cystoscopy is performed in clinic 3 months after surgery to evaluate for recurrence of the stricture. The success rate for urethroplasty is approximately 75-85%.