How is urethral dilation performed

Therapy options

The fundamental problem in the treatment of urethral strictures is that this disease has a high tendency to recur after therapy, since the treatment of these scars can heal again through scars. The likelihood of such a relapse depends on the therapy method chosen.

All of today's established surgical procedures are offered at our clinic, in this way the individual therapy can be optimally adapted to each patient - depending on the previous history and accompanying illnesses.

In principle, the following therapy options are available:

"Minimally invasive":

  • Bougienage / dilation
  • Endoscopic urethral slitting (urethrotomy according to the matter or otis)

 Open surgical:

  • Meatoplasty
  • Strict resection with end-to-end anastomosis
  • Urethral dilatation with free graft (oral mucosa, foreskin)
  • Urethral dilatation with pedicled skin flaps
  • Two-stage procedure
  • Bulboprostatic anastomosis
  • Perineal urethrostomy

The advantage of bougienage and urethral slitting is that they can be performed without a skin incision and are only associated with a short stay in the clinic. However, this is outweighed by the low long-term success rates, as these treatment methods never solve the basic problem of scarring. In more than half of the cases treated in this way, there is renewed tightness. The resulting new stricture is always longer and more difficult to treat than the previous one, which is why these procedures should never be used more than once.

Open surgical surgical procedures offer the greatest chances of success for maintaining a healthy urethra in the long term. Depending on the position and length of the bottleneck, the constriction is completely removed (“strict resection with end-to-end anastomosis”) or expanded with tissue (“graft urethroplasty” or “flap urethroplasty”). The most frequently used procedure here is the dilatation of the urethra with a free tissue graft, so that long-term success rates of more than 90 percent can be achieved.

In this procedure, the urethra is opened lengthways across the entire narrowing and expanded with a piece of tissue removed from another location - usually with a piece of oral mucosa or foreskin.

With this procedure it is possible to reconstruct long-stretching constrictions of the urethra and to obtain a good result in the long term. Constrictions in the immediate vicinity of the urethral sphincter can also be eliminated in this way while maintaining continence.

You can read about how the different procedures are used for the different forms of urethral stricture in the section on the individual clinical pictures.