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Treatment Options for Urethral Stricture



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"Treatment Options for Urethral Stricture"
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Urethra conducts urine from the bladder into the outside environment. In males it is a long tube that travels through various structures including the prostate gland. In females it is a very small tube that opens out into the introitus. Urethral stricture is a disease that develops following a maladaptive healing process of a urethral damage. 

What causes urethral strictures?

Most common cause for urethral injury is trauma. In addition urethral strictures can result from instrumentation and infection (gonorrhea and non-gonococcus infection).

Most common presenting symptoms are difficulty in passing urine and recurrent urinary tract infections. Usually a diagnosis is reached following a retrograde or anterograde urethrograpy. In addition cystourethroscopy can detect urethral strictures.

What are the indications for treatment?

Urethral stricture must be treated if the patient has recurrent urinary tract infections, urine retention, hydronephrosis or stone formation. In addition children are usually considered early candidates for surgery.

What are the treatment options?

It must be said that no single stricture treatment is appropriate for all types of strictures. However, this condition is initially treated with dilatation of the urethra or visual urethrotomy. Apart from a temporary symptomatic relief, these treatment methods usually do not have a definitive curative value. [1]

Urethral dilatation

This is usually done with a dilator called urethral sound. It is inserted into the urethra and dilated. However, repeated dilatations are not recommended. Sometimes endoscopic dilatation is needed. If there are following conditions, urethral dilatation is not performed. They are false passages, urethral inflammation and urethral stones.

Optical urethrotomy

This is done via an endoscope. Here an incision is made in the stricture with the help of direct endoscopic visualization. This procedure can be done with instillation (local) anesthesia [2]. However current evidence does not suggest any advantage of this procedure over urethral dilatation [3].

Urethral stent placement

Another new treatment method is the insertion of indwelling urethral stent. This is especially done in males with bulbar urethral strictures. Usually the stent is inserted following dilatation or urethrotomy.

Surgical correction

Open surgical correction is usually done when above methods fail. It must be noted that the open surgical method has all the disadvantages of a major surgery. But usually it is the only definitive treatment option.

Summary

Urethral stricture disease can result from an injury, infection or following instrumentation. However, it can be treated with various methods. They are urethral dilatation, optical urethrotomy, urethral stent placement and open surgical correction. Each treatment option has its advantages and disadvantages.

Sources

1. Steenkamp JW, Heyns CF, deKock MLS. Internal urethrotomy vs dilation as treatment for male urethral strictures: prospective, randomized comparison. J Urol 1997;157:98

2. Kreder KJ, Stack R, Thrasher JB, et al. Direct vision internal urethrotomy using topical anesthesia. Urology 1993;42:548.

3. Steenkamp JW, Heyns CF, de Kock MLS. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol 1997;157:98.

4. Adult and Pediatric Urology 4th edition by Jay Y., Md. Gillenwater, Stuart S., Md. Howards, John T., Md. Grayhack, Michael, Md. Mitchell

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