Urethral stricture

Urethral stricture is narrowing or complete obliteration of the urethral channel. Any segment may be involved. Patients often have difficulty voiding and emptying the bladder. Strictures can cause major functional, psychological, social, and sexual burden.

Common causes include:

• Trauma — e.g. straddle injury, pelvic fracture
• Infection — e.g. gonococcal or chlamydial urethritis
• Dermatologic disease — e.g. lichen sclerosus
• Congenital anomaly — e.g. hypospadias and its repairs
• Iatrogenic injury — catheterization, endoscopic procedures, prior surgery

Some strictures have no clear cause and are classified as idiopathic.

Typical complaints include difficulty emptying the bladder, painful urination, weak stream, spraying, terminal dribbling, urinary incontinence, recurrent urinary tract infections, and reduced ejaculatory force. Occasionally, symptoms are minimal or absent.

When history suggests stricture disease, imaging and endoscopy help define location and severity. Retrograde urethrogram / voiding cystourethrogram (X-ray with contrast) maps the stricture. Urethroscopy with a thin optic instrument may be needed for direct assessment. Uroflowmetry is usually obtained; flow is markedly reduced when obstruction is significant.

Options for urethral stenosis include dilatation, endoscopic incision (urethrotomy), and open reconstruction (urethroplasty).

1. Dilatation stretches the stricture with progressively larger metal dilators. It is rarely curative and often must be repeated. Pain, bleeding, infection, and creation of a false passage are important risks.

2. Urethrotomy incises the narrowed segment with a cold knife or laser through the scope. It may succeed for very short strictures in favorable locations. Like dilatation, it can injure urethral tissue and worsen stricture disease when used inappropriately.

3. Open urethroplasty is the mainstay of durable repair. Techniques are chosen by stricture location, length, and density of scar. There is no single operation for every case.

Anastomotic repair excises the scarred segment and reconnects healthy urethral ends; it is suited to short strictures in the bulbous / posterior urethra. Substitution may use augmentation with buccal mucosa graft or penile skin flap. Long obliterated segments may be replaced with combined buccal graft and penile skin in one stage. Two-stage repair sometimes places buccal mucosa graft first, with tubularization to a neourethra months later (often around six months).

These procedures are performed in our center with strong success rates in appropriate candidates. Silicone urethral catheters are used for molding and stenting; duration is typically 7 to 14 days, depending on stricture and operation type. A suprapubic catheter may be added to protect the repair and aid healing. After buccal harvest, the cheek donor site is usually closed primarily and heals in roughly three to five days.

Belgrade Genital Surgery continues to refine urethral stricture care, including complex conditions such as urethral diverticulum. Long-term follow-up is essential to judge durability. We compare outcomes with published series and collaborate internationally so that each patient receives a plan matched to anatomy, goals, and evidence-based options.