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Dr. Marco Capece

Specialist in Urology and Andrology

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Urethral strictures surgery

The correction of urethral strictures is essentially surgical. To date, the main therapeutic options are:
  • Endoscopic urethrotomy
  • Urethroplasty
The choice of the most appropriate intervention depends on various factors such as the location and extent of the stricture, its etiology, and the preferences of the patient. Endoscopic Urethrotomy Urethrotomy is an endoscopic procedure specifically designed to treat strictures of the urethral channel. The main objective of the treatment is to incise the stricture, thereby enlarging the urethral channel to allow adequate urination. The technique involves an endoscopic incision of the urethral channel using a “cold” blade under direct vision (Sachse urethrotomy). In recent years, there has also been an option to perform internal urethrotomy using a laser. Among the advantages of this technique are the usually short duration of the procedure, requiring only a few minutes, and its minimally invasive nature. Urethroplasty Urethroplasty is an open surgical procedure aimed at repairing the urethral channel. Depending on the characteristics of the lesion, such as length, cause of the stricture, presence of fistulas or urethral stones, and the condition of the surrounding tissues, the surgeon can select, during the surgery, the most appropriate surgical technique from a wide range of available options.
  • Termino-Terminal Urethroplasty
This procedure involves the complete resection of the compromised urethral segment and the suturing of the two urethral ends.
  • Urethral Dilatation Urethroplasty
The urethra is longitudinally incised and dilated using a graft. Several techniques are available for this dilation; it can be dorsal (Asopa urethroplasty), ventral (McAninch urethroplasty), or double. The most used graft is buccal mucosa harvested from the inner cheek. The stitches are absorbable, and the patient can start eating the day after the surgery.
These types of surgery allow for the repair of the urethra in a single surgical procedure. Among the range of available approaches, we also have techniques that involve correcting the stricture in two stages.
  • Two-Stage Urethroplasty
This approach is primarily utilized for penile strictures: the urethra is incised and opened in a “book” fashion for a length that varies according to the extent of the stricture. This will create a new meatus along the ventral surface of the penile shaft (in more severe cases, at the perineal level). Subsequently, after 6-12 months from the first surgery, the reconstruction of the urethral lumen will proceed. Urethroplasty, while having the disadvantage of being longer and more invasive compared to urethrotomy, offers a higher success rate and a lower incidence of recurrence. A separate discussion deserves the Optilume: an innovative device recently introduced for the treatment of urethral strictures. This instrument is noted for its promising efficacy, particularly in cases of recurrent strictures. Its special feature is the combination of mechanical dilation, achieved through a balloon, with pharmacological dilation. In fact, the device releases paclitaxel, which exerts an antifibrotic and anti-inflammatory effect, thereby reducing the formation of scar tissue and the risk of recurrences. In reconstructive urethral surgery, postoperative management is essential. The postoperative period is generally not very painful and does not require specific dressings; however, it is crucial for the patient to keep the catheter in place for a period ranging from 14 to 21 days, depending on the type of procedure performed. Urethral strictures represent a complex condition that can be treated through various surgical techniques. However, it is important to emphasize that not all procedures are equivalent; each technique has specific indications and associated risks. Therefore, it is essential to consult a specialist experienced in the field to evaluate which intervention is most appropriate for the individual case. Only a qualified professional can provide a thorough analysis of the situation and recommend the most suitable surgical solution, thus ensuring the best possible outcome. See also:
Urethral strictures
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