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Treatment of urethral stricture

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Urethral dilatation and urethrotomy are the methods most commonly used.

  • Urethral dilation (widening) of the stricture using metal or plastic dilators
    • done endoscopically under local or general anaesthesia
    • a stricture can narrow again gradually after dilation, requiring repeat dilation
  • Urethrotomy
    • done endoscopically under general anaesthesia
    • about 50% of people have a successful widening of their urethral stricture after this procedure
    • stricture can reform, leading to repeat procedures

They are particularly suited in:

  • the elderly
  • those unfit for surgery
  • mild strictures

To reduce stricture recurrence, they may be supplemented by intermittent self-dilatation or a permanent urethral stent.

Urethroplasty is indicated in patients suitable for surgery with dense fibrotic strictures or recurrent strictures after urethrotomy

  • offered if dilation or urethrotomy does not work
  • urethroplasty is open surgery done under general anaesthesia and has a higher success rate in resolving urethral strictures, with no further treatment needed compared with existing standard endoscopic treatments
  • a long course of antibiotics may be advised to prevent urine infections until a stricture has been widened

If none of the above are successful then alternatives include:

  • Optilume (Urotronic) (1)
    • a drug-coated balloon indicated for treating urethral strictures in the penis
    • technology combines balloon dilation, to expand or widen the strictured area, with delivering an anti-proliferative drug (paclitaxel) to reduce stricture recurrence, or,
  • proximal diversion may be indicated, either:
    • permanent urethral or suprapubic catheterisation, especially if unfit for surgery
    • surgical reconstruction e.g. ileal conduit

Reference:


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