Detailed resources and procedural information.
A urethral stricture is a narrowing of the urethra caused by scar tissue. Treatment depends on the location, length, severity, and cause of the stricture, as well as the condition of the surrounding tissue.
Treatment options range from minimally invasive procedures, such as high-pressure balloon dilation (HPBD) to urethroplasty, which is a more involved reconstructive operation. Although endoscopic treatments are less invasive and generally have a shorter recovery, they are less durable for many strictures. Urethroplasty offers the best opportunity for a long-term solution in appropriately selected patients.
Our approach is highly individualized. Careful assessment of the stricture and surrounding tissue allows us to select the reconstructive technique that offers the best balance of durability, recovery, and preservation of urinary and sexual function.
The fossa navicularis is the portion of the urethra within the head of the penis. Strictures in this area require specialized reconstructive techniques because the urethra is surrounded by the delicate tissues of the glans and distal penis.
When a stricture is limited to the fossa navicularis and is located at or distal to the corona, the scarred portion of the urethra can often be removed through the urethral opening and reconstructed using a circumferential buccal mucosa graft.
Following trans-meatal grafting, a urethral catheter is typically left in place for 7 days, though more severe strictures may require a suprapubic tube for a total of 2 weeks.
When the urethral tissue is suitable for reconstruction, a one-stage urethroplasty can provide an excellent chance of long-term success. The specific technique depends on the location, length, and severity of the stricture.
For shorter strictures with healthy urethral tissue, the scarred segment can be removed and the two healthy ends of the urethra joined directly. This is known as excision and primary anastomosis.
Long-term success rates are generally around 90% to 95%.
For longer or more complex strictures, the scarred urethra is opened and reconstructed using a graft of the patient's own inner cheek tissue (buccal mucosa). Buccal mucosa is particularly well suited for urethral reconstruction because it is durable, resilient, and well adapted to the urinary environment.
For strictures requiring a buccal mucosa graft onlay, long-term success rates are generally around 85%.
Urethroplasty is a reconstructive operation, and complications can occur. Minor complications such as infection, bleeding, or persistent pain occur in a small percentage of patients. Blood transfusion is uncommon.
Some patients experience temporary changes in ejaculation or post-void dribbling. Short-term erectile dysfunction can also occur after urethroplasty, but it is usually temporary. Persistent or new erectile dysfunction has been reported in approximately 1% to 5% of patients.
When a buccal mucosa graft is used, temporary problems at the donor site can include bleeding, numbness around the mouth, tightness or difficulty opening the mouth, and changes in salivation. These symptoms generally improve substantially during the first few months after surgery.
No urethroplasty is guaranteed to be permanent. If a stricture recurs, treatment depends on the location and severity of the recurrence. In selected cases, a single dilation may provide effective treatment.
Some strictures are too severely scarred or otherwise unsuitable for a one-stage repair. This is particularly true for long, obliterated, or recurrent strictures and for certain strictures associated with lichen sclerosus.
In these situations, a staged urethroplasty can provide a reliable way to rebuild the urethra using healthy tissue.
The first stage is typically a several hour operation. The scarred urethra is opened and carefully reconstructed with a buccal mucosa graft harvested from the inner cheek. The graft is meticulously secured to the underlying tissue to promote optimal healing and graft take.
A dressing is typically maintained for approximately five days, along with a urethral catheter. Patients generally recover over the following several weeks.
After the first stage, the reconstructed urethra is left open as a urethrostomy. This allows patients to urinate through the new urethral opening while the graft matures. Most patients can void effectively and may need to sit to urinate. Erectile function is generally preserved, although ejaculation occurs through the urethrostomy during this stage.
Most patients proceed directly to the second stage when the tissue has healed appropriately. A small percentage require a minor revision before proceeding, sometimes referred to as a stage 1.5 procedure.
The second stage is generally performed 9 months after the first operation. It is usually a shorter, approximately 2-hour procedure.
During this operation, the reconstructed urethral tissue is carefully tubularized to create a new urethral channel, and the surrounding tissue is closed over it. A urethral catheter is typically left in place for approximately 7 days, and a suprapubic tube is left in place for 2-3 weeks.
Long-term success rates for staged urethroplasty are approximately 85%. A urethrocutaneous fistula can occur in approximately 10% of patients; when this happens, it can usually be repaired with a relatively minor subsequent procedure.
An important and sometimes unexpected benefit of staged reconstruction is that many patients are very satisfied with their urinary function after the first stage. Some ultimately decide that they do not want to undergo the second stage because they are comfortable urinating through the urethrostomy. The decision to proceed with the second stage is therefore individualized and based on the patient's goals and experience after the first operation.
Urethral reconstruction is not a one-size-fits-all procedure. The best operation depends on the location and severity of the stricture, the quality of the surrounding tissue, prior treatments, and the patient's goals.
Our goal is not simply to open the urethra - it is to create a durable reconstruction while minimizing complications and preserving urinary, sexual, and quality-of-life outcomes. Complex strictures often require detailed planning and a range of reconstructive techniques, and experience with these operations can be particularly important when the urethra has been previously operated on, irradiated, or affected by lichen sclerosus.