Urethral strictures are an uncomfortable problem for people who have had trauma or surgery on the urethral tract. Where areas of scar tissue have formed on the urethra, there can be some constriction when someone is trying to urinate. This can be extremely unpleasant and can even cause serious problems such as bladder infections. If you have a urethral stricture as a result of surgery or an injury or other trauma, then you will need to have this treated. Here, we are going to look at what your options are.
Diagnosis of Urethral Strictures
You will need to have your urethral stricture diagnosed by a urologist so that you can have a course of treatment prescribed for you that will resolve the issue. It is best to book an appointment with a urologist as soon as you notice the symptoms associated with urethral strictures after having surgery on this area or after an injury, such as difficulty peeing or a burning sensation when you pee. In some cases, it may just be inflammation following the trauma, however, if a stricture is present then you will need to have further surgery to address it.
How Are Strictures Treated?
There are different ways of treating urethral strictures, which depend on the severity and location of the stricture itself. In some cases, you may need to have some tissue grafted into the urethra or you may have to have some scar tissue removed from the urethra, and this can be done via surgery under general anesthetic. Strictures do not usually go away by themselves and so you will need some kind of intervention to make sure that the symptoms that you are experiencing as a result of having strictures in your urethra go away and you are able to experience normal urinary and erectile function.
In order to establish what kind of treatment is best for your specific case, you will need to speak to a professional urologist.
If you have a urethral stricture or are concerned that you may be experiencing the symptoms associated with it, then the best thing to do is make an appointment with a urologist right away. Get in touch with us and you can make an appointment with the best urologist in NYC and put your mind at ease that your urethral stricture will be treated quickly and professionally.
Call us today at 646.205.3039 to schedule an appointment to meet with the best NYC urologist.
An additional test that we find to be very useful to evaluate a stricture is the cystoscopy. This cystoscopy is done in the office and is typically done one the same day as the retrograde urethrogram. After local anesthesia (usually lidocaine jelly) has been placed into the urethra a cystoscope is gently placed into the urethra. The cystoscopy allow direct visualization of the urethra as well as any other anatomic anomalies that may be present in the urethra. In addition, the cystoscopy may also reveal urethral lesions that are not well visualized on a retrograde urethrogram. The downside of the cystoscopy is that often a cystoscope will be too wide to permit passage through the narrow opening of the urethral stricture and, consequently, it can be difficult to estimate the length of the urethral stricture as well as the presence of additional strictures behind the impassable one. For this reason, we feel that a cystoscopy generally should be done in conjunction with the retrograde urethrogram to diagnose and evaluate urethral strictures.
The cystoscopy is useful to evaluate urethral strictures in other ways also. Dr. Purohit and Blaivas have developed and published a staging system for urethral strictures that relies on the use of cystoscopy. It is currently the only validated staging system available for describing urethral strictures. Typically, urethral strictures have been studied using a binary scale (or 2 part) in the medical literature – that is patients are reported as either having a stricture or not. We have found that the simple binary classification of strictures and analysis that are based on the simple binary staging system of strictures is often inadequate to fully describe the range of urethral strictures that patients can develop. Some strictures are very slight narrowing in the urethra that causes no symptoms and may never become a problem for patients. Other urethral strictures, however, are very tight and cause terrible suffering for patients. Our staging system is the first step to better incorporate the large variety of strictures. In our opinion not all strictures should be treated the same – in fact some strictures may not need any surgery at all!
Dr. Purohit and Dr. Blaivas’ approach incorporates the staging system and allows a more nuanced and individualized surgery. The Purohit-Blaivas urethral stricture staging system uses a 4-point system to describe the range of strictures that patients can have; it is based on cystoscopic findings alone. By having a four tiered system, we are able to better describe and study the range of strictures that the patients present with.
The staging system is as shown below.
We will discuss some of the research that has utilized our staging system in a future blog post.