Diagnostics
The diagnosis of a urethral stricture includes the measurement of the urinary stream.This is also called uroflowmetry. The patient’s urine stream is measured on a special toilet. A curve is automatically generated.
The bladder is then displayed using an ultrasound device and the doctor can see whether there is any residual urine in the bladder. Based on the measurements and the amount of residual urine, the urologist can determine whether there is a significant narrowing of the urethra. The position and extent of the narrowing in the urethra is then determined. This is done with the help of an X-ray or a cystoscopy.
Therapy
The treatment of a urethral stricture can vary greatly, as there are different methods that are used in different cases. Which treatment option is the best depends on a number of factors such as the location and length of the narrowing as well as the age and secondary diseases of the patient. The patient’s wishes should also be taken into account as far as possible.
The method known as bougienage is a simple method of dilating the lumen of the urethra. With special urethral catheters, which are available in different sizes, the dilatation of the urethra is performed. The treatment can be carried out by a urologist or according to the patient’s instructions.
By using it, the discomfort can be reduced for a certain period of time, but after some time the method has to be repeated regularly and it also loses its effectiveness over time. In addition, bougienage carries the risk of further injury to the urethra, which can worsen the narrowing. However, depending on the condition and severity of the narrowing, the method can be very helpful.
In this treatment method, the urethral narrowing is slit open under visual control, so that the scar is split in a controlled manner. The procedure is particularly suitable for short narrow spots and promises an improvement. It is usually performed under a short anaesthetic.
The splitting can also be performed with the help of a laser instead of a knife, depending on the circumstances. The laser is a gentle and promising procedure. In the Sachse slit, the constriction is cut into the healthy tissue under visual control to prevent a new scar contracture.
In the Otis slit, the urethra is first stretched to the appropriate and desired width with the help of a urethrotome. A blade is then pulled through the urethrotome, cutting the urethra at 12 o’clock. The Otis method is used for long structures and is more likely to be used as part of palliative treatment of a urethral stricture.
Another possibility is the insertion of a stent. This is an expandable, small tube made of metal or plastic that is inserted into the urethra to keep the narrowed area open. This method also has a disadvantage.
The scar and the mucous membrane of the urethra can repeatedly react to the stent with an excessive growth of scar tissue or with an inflammation. In many cases, the stent must be removed again. Therefore, the insertion of a tube is only performed under certain circumstances during urethral stricture.
In most cases, urethral plastic surgery or urethral reconstruction during surgery promises the best success and long-term results in urethral stricture. In the operation the urethra is opened and the narrowing is removed. Then the ends of the remaining urethra can be sutured together again in an end-to-end anastomosis.
If the constriction was very long and therefore a longer distance must be bridged, a urethral replacement is inserted. In the best case, this is the patient’s own body tissue. This significantly prevents the development of repeated inflammatory reactions.
The foreskin or free oral mucosa is used for the transplant. The operation is complex and technically demanding, which is why it can take up to four hours. Afterwards a bladder catheter remains in the new urethra for about one to three weeks so that the stitches can heal and no infection develops.
