Treatment of urethral stricture

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:

• NICE (January 2021). Optilume for penile urethral strictures