Urethral Stricture Dilation

Overview

Urethral stricture dilation is the process of dilating the lumen of the urethra that has narrowed due to strictures and scars. The urethra is a thin, tubular structure that carries urine out of the body. In men, it serves the additional purpose of carrying semen. Injuries to the genital area, repeated infections, medical tests, and procedures done on the genitals contribute to the development of scar tissue inside the urethra, ultimately leading to stricture formation and narrowing of the urethra.

This leads to symptoms like a decrease in the flow of urine, pain while urinating, blood in the urine and semen, urethral leaking, loss of bladder control, etc. A long-standing urethral stricture ends up damaging your kidneys permanently. Urethral stricture dilation is a process that helps to widen the urethral lumen. It is an outpatient procedure performed at the urologist’s office under local anesthesia. 

What Is Urethral Stricture Dilation?

The urethra is a thin tube that carries urine out of the body. When the lumen of the urethra gets damaged due to different reasons, strictures are formed. These strictures cause difficulty in voiding the urine fully. Symptoms like pain while urinating, bloody urine, loss of bladder control, and urethral leaking are also seen. 

If urethral strictures are not treated at the right time, they can cause permanent damage to your kidneys. Urethral stricture dilation is a procedure that aims to dilate the urethra so that urine can flow freely. This dilation is done under local anesthesia. 

The surgeon makes use of metal or rubber instruments that are inserted into the urethra to widen it. Recent advancements in medical technology advocate using a balloon catheter for the dilation process. Balloon catheters cause less damage to the tissues and feel more comfortable to the patient.

Urethral strictures tend to recur. Hence, the procedure must be repeated as and when the strictures come up. You may also be taught the technique and given the instruments at home to do the procedure yourself. Urethral strictures are more common in men than women, as women have short urethra as compared to women.

When Is Urethral Stricture Dilation Recommended?

Men are more prone to suffer from urethral strictures than women due to their longer urethra. Urethral strictures are rarely seen in women and infants. A urethral stricture will be recommended to you in the following scenarios: 

• When an old injury to the genitals has not healed properly and has led to the formation of strictures
• When you repeatedly suffer from urinary tract infections and sexually transmitted diseases leading to damage of the tissues inside the urethra
• Procedures like cystoscopy or catheterization done improperly in the past
• When you present with symptoms of a blocked urethra like: 
  • Pain while urinating
  • Blood in the urine and semen
  • Difficulty in completely voiding the urine
  • Urinary incontinence
  • Urethral leak
  • Chronic damage to the kidneys, like hydronephrosis and kidney failure

How To Prepare For Urethral Stricture Dilation?

Urethral stricture dilation aims to widen the urethra to facilitate the free flow of urine. Here is a quick guide to help you prepare for the procedure. 

• Discuss your medical history with your surgeon and inform him about-
  • All the medications that you are currently taking for your health conditions
  • Any dietary supplements and herbs that you are taking
  • Allergies towards medicines, if any.
• You can ask your surgeon to explain the details of the procedure along with the outcome and prognosis. You will be asked to sign an informed consent form agreeing to proceed with the procedure.

Before Surgery:

• You will be advised of certain tests before you go in for the procedure. These tests include:
  • Urinalysis- To look for the presence of infections, blood, or cancer
  • Urethral ultrasound- To determine the length of your urethra
  • Urinary flow test- To check for the strength and amount of urine flow
  • Pelvic ultrasound- To check for the presence of the amount of urine remaining in the bladder after urinating
  • Cystoscopy- To examine the inside of the urethra and bladder
  • Retrograde urethrogram- An x-ray test to check for structural problems in the urethra, the location of the stricture, and the extent of the narrowing of the urethral lumen.
• You will be asked to stop medications like blood thinners (to prevent excessive bleeding during and after surgery) a week before the procedure.
• You will be asked to arrange for a friend or relative to drive you home after the procedure.

How Is Urethral Stricture Dilation Performed?

Urethral stricture dilation is an outpatient procedure that is performed in the urologist’s office. The procedure takes only a few minutes. The procedure for urethral stricture dilation remains the same in men and women. Here is what will happen during the procedure.

During Surgery:

• You will be administered local anesthesia. General anesthesia is an option in certain cases. After assessing your general health condition, your doctor will choose the one that is right for you.
• The doctor will now insert thin rods of increasing diameter inside the urethra, gently widening it.
• The rods are generally made of rubber or metal.
• A special type of catheter, the balloon catheter, is also used for stricture dilation. This involves inserting the balloon catheter. Once in, the balloon is slowly allowed to open. In the process, the urethral lumen gets widened too.
• Urethral stricture tends to recur. You will be taught the procedure and also provided with the instruments so that you can do the procedure yourself at home.

What Happens After A Urethral Stricture Dilation?

Urethral stricture dilation takes about 5 to 10 minutes to get completed. Once the procedure is done, you can go home immediately. Your doctor will give you a list of things to expect while you recover at home.

After Surgery:

• There may be burning at the urethra for a couple of hours at the procedure
• You will feel the need to urinate more frequently 
• You will have burning urination for a day or two
• After the procedure, expect some blood or brownish pigments in the urine for a couple of days.
• Your bladder will be drained at the clinic to avoid discomfort and a catheter is left in place for a few days to allow the urethra to heal.
• Drink plenty of fluids to flush out your bladder.
• You can resume work in 1 to 2 days after complete recovery.

Are There Any Complications Associated With Urethral Stricture Dilation?

The urethral stricture dilation procedure has a few complications. Your doctor will explain and prepare you to deal with these.

• You may suffer from allergic reactions to the anesthetic agent.
• Strictures not only recur after dilation but also worsen with repeated procedures.
• Stricture dilation involves the insertion of thin rods that increase the chances of infection. 
• There may be damage to the tissues of the urethral lining. This can lead to bleeding and infections. 
• The damage caused by the tubes can lead to urethrocutaneous fistulas.
• You may suffer from problems with having an erection.

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