Urethral stenosis

It is the narrowing of the tube that carries urine from the bladder to the outside.

It is a rare disease that requires very specialized equipment in the management of these pathologies to obtain good results. This is recognized even by the Ministry of Health and it recognizes reference centers for the management of these diseases. Our team is one of the two recognized in Spain and accredited for the treatment of these diseases.

The causes of urethral strictures are varied:

• Idiopathic or of unknown origin.
• Traumatic: due to an accident or manipulation.
• Iatrogenic, produced by medical action: catheterizations, endoscopic procedures: cystoscopies, surgeries, etc.
• Infectious: urethritis, sexually transmitted diseases.
• Lichen sclerosus or balanitis xerotica obliterans: it is an autoimmune disease of unknown cause, with genetic predisposition.

Urethral stenosis produce obstructive symptoms of the urinary tract, consisting of a sluggish, short stream, prolonged urination time, incomplete emptying of the bladder.

Some patients may present erectile dysfunction, difficulty in ejaculation, repeated urinary tract infections. All this can alter the patient’s quality of life and psychological problems.

Diagnosis is made on the basis of symptoms and with the help of diagnostic tests:

1. Flowmetry: measures the flow of urination.
2. Urethroscopy: using an endoscope, the urethra is observed from the inside to observe the areas of narrowing and the appearance of the mucosa.
3. Retrograde and voiding urethrography: consists of the introduction of contrast through the urethral meatus until it fills the bladder. X-rays are taken of the urethral pattern during bladder filling and emptying. We can know the number of strictures, their length and location.
4. Urethral calibration: to know the diameter of the stricture.

In the treatment of strictures there are several options.

The performance of these surgical techniques requires very specialized equipment. This type of intervention, due to its complexity and exceptionality, should be in very few hands. Only accredited groups should treat urethral strictures.

Urethral dilatations consist of introducing progressively thicker dilators or plugs into the urethra to dilate the narrow area of the urethra. It is a palliative option that does not solve the problem, but can improve the symptomatology momentarily. They should be performed periodically since their effects are temporary. We do not recommend them except in very selected cases. In the medium and long term they can even cause worsening of the stricture and make permanent resolution of the stricture increasingly difficult.

Internal urethrotomy consists of sectioning or cutting the narrowed area endoscopically (from inside the urethra and under vision). It can be performed with laser or cold cut. The percentage of recurrence of stricture is very high, between 58-84%. It is usually performed in short strictures (less than 1 cm), unique and without previous treatments.

Terminal-terminal urethroplasty consists of removing the affected area of urethral mucosa and re-suturing the mucosal strands. It is performed in strictures smaller than 2 cm.

For stenosis of greater length, the urethroplasty technique with interposition of grafts or flaps is used. This surgery can be performed in one or two surgeries. The stricture is removed and the affected urethral mucosa space is replaced by other tissue. Many types of grafts have been used, but in recent years the use of the patient’s own oral mucosa has become popular, achieving good results.

If there is one type of intervention that requires to be handled in high volume centers and groups of excellence, it is this one