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
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