A urethral stricture is a condition that occurs when the urethra (the tube that carries urine from the bladder) narrows for various reasons. This condition not only obstructs urine flow but can also negatively impact bladder and kidney function over time. The goal of treatment is to reopen the narrowed area and restore normal urine flow. Treatment for a urethral stricture is planned considering the cause of the disease, the location and length of the stricture, and the patient's general health.
Endoscopic (Closed) Treatment Methods
Endoscopic procedures are usually the first choice for patients with a urethral stricture. In this procedure, a thin camera is inserted into the urethra to directly visualize the narrowed area. The most common procedure is known as internal urethrotomy. In this technique, a small incision is made at the site of the stricture and the inside of the tube is widened, allowing for easier urine flow.
In some patients, dilation, or gradual widening of the urethra using special bougies, is preferred. This method is particularly effective for short, first-time strictures. However, dilation usually provides temporary relief; the risk of recurrence is high. Therefore, the patient should be followed up regularly after treatment.
Laser-assisted urethrotomy techniques have become increasingly common in recent years. These procedures, performed using laser energy, cause less tissue damage than traditional incisions, have a lower risk of bleeding, and have a shorter recovery time. Laser surgery is preferred, particularly for short-segment strictures, with a high success rate.
Open Surgical (Reconstructive) Procedures
Open surgical treatment, also known as urethroplasty, is recommended for recurrent, long, or complex urethral strictures. Urethroplasty is an advanced surgical procedure that completely removes the narrowed portion and reconstructs the urethra. In short strictures, the ends of the urethra can be directly connected, while in long strictures, tissue grafts taken from the oral mucosa (especially the inner surface of the cheek or tongue) are used. This tissue is added to the urethral wall, reconstructing the urethra.
A properly planned urethroplasty provides a long-term, permanent solution. The success rate of this procedure is around 85–90% in the literature. However, it is crucial that the surgery be performed by experienced surgeons to reduce the risk of recurrence.
Post-Treatment Process and Follow-Up
Careful monitoring is crucial after urethral stricture surgery. A urinary catheter is left in place for a period after the surgery to ensure proper wound healing. Patients are generally advised to take a short course of antibiotics and consume plenty of fluids.
Uroflowmetry (a urine flow rate test) and, if necessary, endoscopic checks are performed during the follow-up period. If any signs of a stricture are detected early, it can be reopened with minor interventions.
Conclusion
Urethral stricture treatment requires personalized planning. Endoscopic methods are sufficient for simple cases, while recurrent or prolonged strictures may require open surgery. Thanks to developing technologies, laser-assisted treatments also yield highly successful results. With early diagnosis and the correct surgical procedure, urine flow returns to normal in the vast majority of patients, and their quality of life is significantly improved.