The urethra is the channel that allows urine to be expelled from the bladder, extending between the bladder and the tip of the penis. Urethral stricture occurs when a narrowing develops in any part of this channel, making urine flow difficult. When a stricture develops, urine cannot be fully emptied from the bladder, which both reduces daily quality of life and can lead to serious health problems in the long term.
Urethral strictures generally develop after infections, trauma, previous surgical procedures or endoscopic interventions. The length of the stricture can vary from a few millimeters to a few centimeters, and once it forms it does not heal on its own.
What Are the Symptoms of Urethral Stricture?
The most common complaints in patients with urethral stricture are:
Weak and split urine stream
Difficulty and pain when urinating
Feeling of frequent urination
Feeling that the bladder is not fully emptied
Dribbling after urination
Recurrent urinary tract infections
When left untreated, constant pressure builds up in the bladder, which over time can cause enlargement of the kidneys and permanent kidney damage.
How Is Urethral Stricture Diagnosed?
The diagnosis is confirmed after a detailed patient history and physical examination with:
Urine flow test (uroflowmetry)
Endoscopic examinations
Radiological imaging methods
The location, length and severity of the stricture are critically important in determining the treatment plan.
Urethral Stricture Treatment
Treating urethral stricture with medication is not possible. The treatment is entirely surgical, and the method to be used is determined specifically for each patient.
Treatment Options:
Surgical widening of the urethra
Cutting the stricture open with a closed method (internal urethrotomy)
Open surgical method: Urethroplasty
For recurrent, long or severe strictures, the most effective and permanent method is urethroplasty surgery.
What Is Urethroplasty Surgery?
Urethroplasty is the gold standard surgical method that allows urethral stricture to be treated permanently. The main aim of the surgery is to remove the narrowed urethral segment and reconstruct it with healthy tissues.
Who Is Urethroplasty Suitable For?
Patients with recurrent urethral stricture
Patients who have undergone multiple closed operations without benefit
Patients whose stricture length is over 2 cm
Patients who have experienced urethral rupture due to trauma
Strictures that develop after radical prostate surgery
How Is Urethroplasty Performed?
Different techniques are used according to the length of the stricture:
For short strictures (up to 2 cm): The narrow segment is removed and the ends are sewn together to create a new urinary channel.
For long strictures: If end-to-end suturing is not possible, a patch is made using cheek mucosa (inside the mouth), penile skin or bladder mucosa.
The surgery usually takes 2 to 3 hours. Depending on the location of the stricture, the incision is made on the underside of the penis or under the scrotum. After the surgery the patient remains catheterized for 2 to 3 weeks.
Advanced and Multi-Stage Cases
In some patients the urethra may be completely closed. In these cases:
In the first stage, the urinary channel is temporarily brought out to the skin under the scrotum
Approximately 6 months later, the urethra is reconstructed with a second surgery
These methods provide successful results especially in difficult and advanced strictures.
Success Rate and Results
The success rate in treating urethral strictures with open surgery is around 90 to 95%. With correct patient selection and an experienced surgical approach, patients can achieve healthy urinary function in the long term without experiencing recurrent stricture.
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