Different treatment options
The therapy for urethral strictures depends on numerous factors. At first, the doctor will consider the extent and location of the stricture and in this regard the related restrictions for the patient. Then the cause of the stricture is considered. A tumor needs to be removed as much as possible while fresh lesions and acute inflammations call for traditional treatment and awaiting the healing process before any decision for or against surgery can be taken. During that period, the urethra is possibly protected with a suprapubic bladder catheter. Depending on the cause of the urethral stricture (for example lesions or inflammation), the patient receives appropriate medication, such as decongestants or antibiotics. The condition and the anamnesis of the patient are valuable for the decision regarding the right therapy, too. Other important aspects are the age and significant accompanying diseases, but also the question if it is a first-time disease or a relapse.
Urethral stricture – Overview of the invasive methods
Depending on the location of the stricture and the danger for relapse, the appropriate treatment for the individual patient can be chosen from among the following therapy options.
Dilating the urethra is a comparatively simple form of treatment. In some cases, it can be done by the patients themselves, with the help of disposable catheters that are covered with a special lubricant. Regularly applied, the same treatment is called long-term dilation. Urethral dilation comes with a variety of disadvantages which do not usually make this form of treatment the preferred choice: On the one hand, the success of dilation is only temporary and on the other hand, this treatment worsens the symptoms with time due to the repeated mucosal irritation and micro lesions.
With the help of a stent, a dilated urethra is supposed to be prevented from narrowing again. The stent is a small strut made from delicate wire meant to keep the channel open. However, this method is not used all too often: Some of the disadvantages are scar tissue formation entering the wire netting as well as chronic infections of the urethra due to bacteria around the stent.
Experiencing a first-time urethral stricture, the endoscopic cut of the urethra is a possible treatment. Requirements for this treatment are the first-time appearance of the stricture as well as an affected area of not more than 1.5 centimeters. The advantage of this treatment, which requires a splint for approximately one day after surgery, lies in the fact that it is of very short duration and healing time. But this treatment also comes with a number of disadvantages. One of them is the fact the already scarred tissue is cut into and every cut brings about a new scar so that another stricture follows in the short-term. Usually, the scar is longer after every cut and there is less and less tissue left to create an opening or a tube for the urine flow. Every repeated cut will therefore lead to a worse situation of the patient and also implies the danger of irreversible damage on the urethra.
Repeated cuts should therefore be rejected.
To remove parts of the urethra in connection with an implant of urethroplasty can only take place during open surgery. If the affected part of the urethra is not longer than 1.5 centimeter and is located around the penis shaft, the surgeon can connect the two ends of the urethra that were created by removing the affected part. The connection is called anastomosis and the surgeon can connect and seam them together. The disadvantage of this treatment is that it can lead to a chordee and erectile dysfunction for an extended period.
A longer piece is often covered with urethroplasty which is often based on a piece of oral mucus from the patient. The advantage of this treatment lies in the relatively small chance for relapse. On the other hand, risks and damages caused by removing oral mucus do exist.