Treating Urethral Stricture
- Dilation - Usually first-line treatment for urethral stricture is dilation (sometimes
called dilatation), which is widening of the urethral stricture. This is sometimes
performed during the initial cystoscopy or a subsequent one. Traditionally, urethral
dilation was accomplished using a series of progressively larger metal dilating
instruments; however, Dr. Safir may be able to perform dilation using an inflatable
balloon catheter, which works to relieve urethral stricture in the same way a balloon
angioplasty dilates clogged arteries. It is important to recognize that according
to clinical studies, dilation has not been shown to have long-lasting results for
many patients. Much better outcomes can be achieved by using surgical methods.
- Minimally invasive surgery - If possible, Dr. Safir will perform a minimally invasive surgery to correct the urethral stricture. Most often, this surgery is a urethrotomy.
- Urethrotomy - A urethrotomy is a minimally-invasive,
endoscopic procedure for urethral stricture. An endoscope, a lighted tube containing
surgical instruments, is inserted into the urethra until the stricture is reached.
Then, a tiny blade located in the endoscope makes cuts into the area of the urethral
stricture; this helps to open up the affected area. An indwelling catheter (a catheter
left in after surgery) is placed in the urethra to keep the treated area open through
the healing process. Alternatively, a urethral stent may be placed, which will reside
permanently in the urethra after the initial urethrotomy procedure.
Dr. Safir usually can perform this procedure under general or spinal anesthetic in under a half hour. You will usually be able to return home the same day and go back to work in a few days.
- Urethroplasty - If minimally invasive options are not possible,
Dr. Safir will perform an open urethroplasty . A drawing or diagram could be nice
here.
This technique involves resection and anastomosis. That may sound complicated, but
the idea is quite simple. First, the section of scar tissue in the urethra causing
the stricture is cut out (resection). Then the remaining, normal ends are joined
back together (anastomosis).
Occasionally, urethroplasty requires a more involved approach, such as taking a
tissue graft from the inside of the cheek to augment the urethra. Because of Dr.
Safir’s extensive training in reconstructive urology, he is very experienced in
performing the complex reconstructions that may be necessary.