Urethral Stricture

Treatment Options

Urethral stricture requires corrective treatment only if symptoms are noticeable, such as slow flow of urine. Without treatment, a symptomatic stricture will almost certainly come back. Even with treatment, strictures commonly recur. The right treatment for urethral stricture depends on location, size and symptoms.

Temporary, or Short-term, Treatment

In some cases, a urethral stricture can cause acute pain or completely block urine flow, which may require immediate treatment, such as:

• A suprapubic catheter, a tube through the abdomen to drain the bladder
• A nephrostomy tube, which is inserted in the patient's back to directly drain the kidney (percutaneous nephrostomy).

Catheter

Simply inserting a catheter may correct a short stricture and open the urethra, if applied periodically. This treatment requires the patient to do self-catheterization at home. Catheterization is not as useful for long strictures.

Dilatation

This procedure dilates (gradually opens) the urethra. A tiny wire is inserted through the urethra into the bladder, and progressively larger dilators are passed over the wire.

Endoscopic Internal Urethrotomy

This minimally invasive procedure is most effective for short to medium strictures of the urethra. A rigid tube with an attached optical system, called a cytoscope, is inserted into the urethra. The physician can then look inside the urethra to locate the stricture. Instruments are inserted through the tube to cut open the stricture with a knife, laser or electrocautery (electric pulses that vaporize the scarred tissue). This minimally invasive procedure requires general anesthesia.

The benefits to patients are more rapid recovery, minimal scarring and less risk of infection.

Urethral Reconstruction

In many cases, the most effective treatment is to surgically remove the narrowed section of the urethra. The spliced ends of the urethra are then connected. Sometimes, the urethra is connected using a skin graft.

Implanted Stent or Permanent Catheter

For a patient who chooses not to undergo surgery, or who has a severe stricture, the best treatment may be implanting a permanent stent (artificial tube) to keep the urethra open, or a permanent catheter to drain the bladder.

Disadvantages to these treatment options are that they can irritate the bladder, be uncomfortable, cause urinary tract infections, and require close monitoring.

Monitoring for recurrence

Once treatment is completed, frequent follow-up exams will be needed for at least one year to ensure that the stricture and any urinary tract infections do not recur. Mayo Clinic works closely with the patient's local primary care physician during follow-up.