Urethral stricture is an uncommon condition that results in blockage of the urethra (the tube that lets urine leave your body). Stricture formation results in a narrow circular ring of scar tissue, which restricts the flow of urine. Without treatment, urethral stricture can cause multiple urinary tract complications.
The University of Kansas Health System in Kansas City is one of the only locations in the United States to offer buccal mucosa urethroplasty, an advanced surgical option for repairing urethral stricture. Because we’re part of an academic medical center, we can offer the most leading-edge treatments for urethral stricture, along with access to clinical trials.
What is urethral stricture?
Urethral stricture can limit or completely block the flow of urine from the body. This can cause a number of complications, including inflammation and urinary tract infections. Urethral stricture occurs more frequently in men than in women, and the cause often cannot be identified.
Urethral stricture symptoms and risks
The symptoms associated with urethral stricture include:
- Feelings of incomplete emptying
- Frequent urination
- Recurrent urinary tract infections
- Slow urine stream
- Straining to void
In those who are seriously injured, blood in the urine may also be seen. In severe cases, urinary retention may prevent individuals from urinating completely and may require emergency intervention.
The most common cause for urethral stricture is trauma from being struck in the area between the legs, known as the perineum. There are other possible causes as well, including inflammatory diseases such as lichen sclerosis or other infections, sexually transmitted diseases, congenital abnormalities or a previously performed surgery. However, the cause of the majority of urethral strictures is unknown.
Urethral stricture diagnosis and screening
Correctly diagnosing urethral stricture starts with a thorough history and physical. The majority of patients will require a retrograde urethrogram, or RUG. This is an outpatient X-ray test that shows the location, density and length of the urethral stricture and is required for planning a repair. Additional tests your doctor recommend can include insertion of a camera into the bladder, called cystoscopy.
So the procedure that we just did today is actually a repairing a deep bulbar urethral stricture. So deep in this particular patient, he had an area that was starting to narrow and was not allowing him to urinate. So what we did is take a piece of the inside of his mouth, harvested by one of our ENT colleagues, we defatted that on the back table here.
Opened up the strictured area so the strictured area came down narrowed like an hour glass.
OK, so normal urethra is up here. Move. Right in there. That's wide open. In fact you see how nice that looks. Wide open.
Then you can see it starts getting diseased right in here and then you can actually see this little, it's almost like a little cliff sitting there, a little ledge. And that's the strictured area and then it gets normal again right back here. You see it? Suck there. Suck underneath here. So it's normal opening right there.
What we're doing is we're gonna put the flap in right in here. So we're gonna be putting this flap in right in here so you can see the little strictured area there. This is normal. This normal. We're going to be suturing it all in here. We opened that up, measured how much we needed. Sutured the inside of what's called buccal mucosa, which is the lining on the inside of the mouth.
That lining we measured and then sutured that with the skin side or the mucosa side, which is the portion you touch with your tongue in toward the urethra. We sutured all of that in and once that's sutured in we've now given a wider caliber to the urethra so this gentleman will be able to urinate.
Now, that graft has to take. In other words, it has to recruit its own blood supply so that will take two days or so while this patient is on bedrest. They have very little discomfort from it.
There aren't many places doing this in the country. In fact, we have one of the largest series in the country and so this is sort of a specialty specific procedure that we do that I think has been very successful. We actually have a 96 percent success rate and we followed our patients now for up to five years.
Urethral stricture treatment
The treatment for urethral stricture is customized to fit each individual. Most urethroplasties require an overnight stay in the hospital.
This is the simplest form of urethroplasty in which the scarred portion of the urethra is removed, and the 2 ends are sewn together.
This specialized technique is only performed by a few surgeons in the United States. The inner lining of the mouth is harvested to create a patch over the scarred area of the urethra. The buccal mucosa is transplanted to the area of repair, where it will grow new blood vessels. The tissue heals very well, is resistant to infection and seems to remain effective for many years after repair. The majority of patients are back to eating normal food after just 48 hours. This does not cause facial scaring or difficulty with speech.
This minimally invasive surgery to correct urethral stricture can involve internally leading or dilating the scar with the aid of a camera. This requires no external incisions and can be performed on an outpatient basis. For the majority of people, however, this treatment may only produce temporary results. Most will go on to require some form of open repair, which is accomplished in a variety of ways.
This technique involves harvesting a portion of skin from the penis in order to place a patch over the narrowed portion of the urethra. The skin remains connected to the muscle and underlying blood vessels.
A specialized technique to repair urethras that have been severely injured due to pelvic fracture, which causes a disruption of the urethra with massive scar formation. The scar must be carefully removed, and the urethral ends reconnected.