Urethral Stricture and Urethroplasty

What is Urethral Stricture?

Urethral stricture is a condition characterized by scar-forming inflammation of the lumen of the urethra, the canal that carries urine from the bladder to the external urethral meatus in men and also allows the passage of semen during ejaculation. This stenosis can be congenital or acquired due to inflammatory infections of the lower urinary tract. It can also be caused by internal trauma, such as the use of endoscopic instruments or catheters, or external trauma, such as after trauma to the pelvis or perineum. Often, however, the inflammatory process underlying scar retraction may remain silent, so the cause of the stricture remains unknown. It is also possible that the cause of the stricture is not inflammatory.

Types of Urethral Strictures

Anterior Urethral Stricture

The anterior urethra is a canal whose wall is formed by the corpus spongiosum which ensures normal urine drainage. It is the corpus spongiosum that is the area of inflammatory and fibrotic processes that ultimately determine urethral stricture.

Anterior urethral strictures can be:

• Congenital;
• Post-inflammatory (Lichen sclerosus);
• Iatrogenic (catheterization, surgery and endoscopic urethral diagnosis and urethral catheterization, especially if repeated);

Posterior Urethral Stricture

The posterior urethra is a canal constituted by the structures it traverses, namely the prostate and the external urethral sphincter. The mucosa of the posterior urethra is surrounded by musculature that ensures the sphincter mechanism. At this level, the origin of the stricture is generally pelvic trauma. Posterior urethral stricture can be post-traumatic.

Complications of Urethral Stricture

If prolonged and not treated promptly, urethral stricture could favor the appearance of certain complications, such as:

• Recurrent cystitis and prostatitis;
• Fistulas: Certain infectious processes starting from the urethra or peri-urethral tissues can become complicated and cause abscesses and fistulas in the genital region. To maximize effectiveness, it is important to take rapid measures to treat these conditions, as they can lead to potentially fatal sepsis.
• Urethral diverticula: When there are congenital malformations of the urethra or complications following urethral reconstruction surgery, the need to make the text more human is particularly important.
• Bladder or urethral stones: These solid structures manifest in the urinary tract and cause suffering, bleeding, infection, and obstruction of urinary flow.

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What is Urethroplasty?

Urethroplasty is a surgical procedure used to treat urethral stricture, a condition that can cause difficulty urinating. This operation, which requires an incision, is considered a delicate combination of microsurgery and plastic surgery, aiming to meticulously reshape the genitals. Because of the great importance of this delicate area, it must be performed by highly qualified and experienced specialists.

What are the complications of urethroplasty?

The probability of complications during urethroplasty is less than 10%. These complications are mainly bleeding, fistulas, infections, etc.

The probability of complications is reduced by:

• Meticulous surgical precision;
• Adequate surgical instrumentation;
• Speaking from personal experience with a specialized surgeon who performs more than 100 urethroplasty operations each year;

Different types of urethroplasty

Anastomotic Urethroplasty

Anastomotic urethroplasty is essentially performed in the following steps:

1. Full-thickness section of the urethra;
2. Resection of the fibrosclerotic tissue, the cause of the narrowing of the urethral canal;
3. Reunion of the two urethral ends;

Urethroplasty with buccal mucosa graft

In the case of urethroplasty with a buccal mucosa graft, the urethral tube is opened (lengthwise) at the level of the stricture and widened by a buccal mucosa patch.

Buccal mucosa is the tissue of choice for use in urethral surgery. Buccal mucosa has proven to be a remarkably resistant and suitable tissue for replacing the urethra. Its use has thus replaced that of penile skin which, often poorly accepted, requires circumcision.

The graft is extracted from the cheek and the wound is sutured. Discomfort in the mouth only lasts a few days, the patient can resume eating the day after the operation and the stitches dissolve spontaneously after about a month.

Urethroplasty with other urethral replacement tissues

In addition to buccal mucosa, other tissues can be used during urethroplasty:

• Penile skin: Until 10 years ago, this was the most commonly used urethral replacement tissue. Its use has decreased since the discovery of the use of buccal mucosa for two reasons: buccal mucosa is more resistant and avoids the need for circumcision;
• Skin from other areas of the body;
• Heterologous tissues: These are tissues derived from animals or constructed in the laboratory. They have been used in some cases, but the result still needs to be evaluated over time;
• Cell cultures: The culture of tissues in the laboratory and the use of stem cells are still at an experimental stage and are still far from being applicable to this surgery;

Two-stage urethroplasty

In two-stage urethroplasty, the urethra is reconstructed by means of two or more operations performed at least six months apart. This technique is reserved for the most complex cases.

After the first procedure, the urethra will be left "open" for a few centimeters and the patient will urinate through an opening located along the ventral side of the penis or scrotum. In subsequent procedures, the continuity of the urethra will be restored and the patient will be able to urinate again from the original urethral meatus.

Postoperative and Convalescence Urethroplasty

Following urethroplasty surgery, the patient stays in the hospital for about three days and keeps their catheter for 10 to 20 days, depending on the type of procedure. The post-operative phase is not excessively painful and does not require special dressings. Note the signs of a wound infection such as skin redness, the presence of pus, and also fever. If you experience these symptoms, it is strongly recommended to consult a doctor.