Urethrotomy For Urethral Stricture Treatment

Urethrotomy For Urethral Stricture Treatment

Urethral stricture is a condition that many people are unaware of, yet it significantly affects the lives of those affected and leads to various complications. Therefore, Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, presents the latest methods and techniques for treating urethral stricture. Thanks to his expertise, this condition is treated through a urethrotomy using laser technology (laser-assisted urethral stricture incision), achieving complete recovery with the highest levels of safety.

What is urethral stricture?

• The urethra is the tube that carries urine from the bladder to the outside of the body. Normally, the urethra is wide enough to allow urine to flow freely through it.
• In the case of a urethral stricture, a narrowing occurs in part of this tube, which can affect any section of the urethra from the bladder to the urinary opening.
• Urethral stricture affects both men and women, but it is more common in men due to the longer length of the urethra.

Why does urethral stricture occur?

Urethral stricture occurs because of several causes, including:
1. Chronic inflammation: Chronic inflammation is one of the most common causes of urethral stricture. These inflammations may be caused by an infection in the urethra, such as gonorrhea.
2. Congenital defects: Urethral stricture can be caused by a birth defect of the urethra or by birth defects that cause the opening of the urethra to be misplaced.
3. Tumors: Some tumors in or near the urethra can cause urethral stricture, but this is a rare cause.
4. Scar tissue: Scar tissue narrows the urethra, making it more difficult for urine to flow. Scar tissue may form gradually due to several reasons, such as: 
- Trauma: Trauma to the urethra or pelvis is also a common cause of urethral stricture. Falls, pelvic fractures, or accidents affecting the scrotum or perineum (the area between the scrotum and the anus) can lead to scarring. Symptoms of urethral stricture may not appear until years after the injury.
- Urethral injuries: Injuries to the urethra may occur due to the insertion of a urinary catheter or because of certain surgical procedures. These injuries can lead to the formation of scar tissue that causes the narrowing of the urethra.

What are the symptoms of urethral stricture? 

Symptoms usually appear when the narrowing of the urethra is significant enough to reduce the urine flow rate, which is one of the most common symptoms of urethral stricture. Other possible symptoms may include:
• Difficulty emptying the bladder.
• Decreased urine output.
• Dysuria (painful urination).
• Intermittent urination.
• Pain in the penis or perineum.
• Bloody or dark-colored urine.
If the urethral stricture is severe, it may result in the complete inability to urinate. This sudden condition is known as acute urinary retention, a medical emergency. Without prompt treatment, acute urinary retention can cause urine to accumulate in the kidneys, potentially leading to kidney failure.
Therefore, if you experience any of these symptoms, it is important to consult Dr. Enmar Mohamed Habib for accurate diagnosis and to prevent complications.

Complications of urethral stricture:

Without treatment, the urethral stricture can prevent the bladder from emptying, leading to urine stagnation in the urinary tract. This can result in several complications, such as: 
• Recurrent urinary tract infections (UTIs).
• Formation of stones in the urinary tract.
• Kidney failure in cases of urine retention.

Diagnosis of urethral stricture:

Several methods are used to diagnose urethral stricture. Some of the common tests include:
1. Voiding cystourethrogram (VCUG): This type of X-ray uses a contrast dye to help identify the length and location of the stricture.
2. Urine flow test (uroflowmetry): This test measures the strength and speed of urine flow.
3. Blood tests: To detect the presence of inflammations or gonorrhea.
4. Physical examination: A physical exam can help detect redness or swelling in the genitourinary area, which may indicate urine buildup due to a urethral stricture.

Treatment of urethral stricture:

There is no effective medication to eliminate urethral stricture. Several surgical options are available depending on the severity of the blockage and the amount of scar tissue present. Some of the available treatment options include:
1- Dilation:
During this procedure, the urethra is widened using dilators or long, thin wires inserted through the urethra to the bladder. These dilators gradually increase in size until the urethra is expanded. Some complications of this procedure include bleeding and infection. Additionally, a false passage or a false urethral channel may sometimes develop because of the dilation.
2- Surgical urethral reconstruction with grafting (Urethroplasty):
In this procedure, a surgical incision is made between the scrotum and the rectum. After removing the stricture, the urethra is reconnected surgically, and a catheter is placed until the urethra heals completely. In some cases, the stricture may be too long to be removed surgically, necessitating the replacement of the strictured section through a urethral grafting step. Urethral grafting is performed using tissue from the penis or scrotum to reconstruct the urethra.
3- Urethral stenting:
This treatment is suitable for individuals with severe urethral stricture who cannot undergo surgery. A permanent stent is placed to keep the urethra open. 
These traditional options usually cause a lot of complications due to surgery and open incision, such as infection, bleeding, infertility, and high rates of urethral stricture recurrence. Therefore, Dr. Enmar Mohamed Habib is keen to provide the latest minimally invasive treatment methods and techniques. Urethral stricture can now be safely treated using the holmium laser.

Laser urethrotomy for urethral stricture:

The use of holmium laser technology is one of the latest methods for treating urethral stricture. A flexible endoscope is inserted into the urethra, through which the holmium laser is directed to remove the stricture. The holmium laser directly cuts the stricture, helping to prevent further narrowing of the urethra. This is done with high precision, ensuring the removal of scar tissue while preserving the surrounding tissues.

Advantages of laser urethrotomy for urethral stricture:

• Using laser technology to treat urethral stricture is a minimally invasive procedure that does not require any surgical incision.
• It removes scar tissue without causing thermal damage to the surrounding genitourinary tissues.
• Unlike traditional surgical methods, it does not leave additional scarring in the urethra from surgical instruments, which significantly reduces the risk of stricture recurrence.
• The use of the laser ensures that there are no complications, such as bleeding because the holmium laser closes the veins and arteries that may cause bleeding.
• It also offers a shorter recovery time compared to other surgical methods.

In conclusion, urethrotomy using a holmium laser has become the ideal option for treating urethral stricture due to its numerous advantages. With the expertise of Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, patients can enjoy the best treatment solutions safely, without the need for open surgery and complications. Don't hesitate to get your consultation now.