Urethral Reconstruction Treatments

Treatment of urethral strictures was traditionally the dilation of the urethra either blindly or in the operating room with a balloon or an incision to allow visualization with a camera.

However, in the majority of patients this leads to only temporary relief with stricture recurrence within weeks to months. In the past two decades, it has become apparent that only surgery allows for the complete removal of the scar tissue. Although stricture recurrence still occurs, the rates are low and overall patient satisfaction excellent.

Strictures that are located closer to the bladder can typically be treated with removal of the scar and reconnection of the urethra. For those located closer to the tip of the penis or for those that are fairly long, other tissue is used to form a new urethra of sufficient diameter. These tissues can either be taken from penile skin or from the inside of the cheek. The latter has shown to be superior when it comes to forming part or all of the new urethra in regards to success rates and is surprisingly well tolerated.

Most operations can be performed as outpatient surgery or with an overnight stay in the hospital. As the incisions are usually small the vast majority of patients tolerate the procedures very well and report little pain afterwards.

Patients are typically most bothered by the use of the catheter, which unfortunately is a necessity as it provides the scaffolding over which the reconnected or the newly formed urethra will heal. Catheters are routinely removed after two to three weeks.

In experienced centers, stricture surgery has durable success rate of >95 percent. For the small subset of repairs that are very complex, for example those involving long segments of the urethra the success rates are about 85 to 90 percent.