Urethral stricture is a narrowing of the water pipe (urethra) caused by scar tissue due to previous catheters, surgery, infection or trauma - usually in the setting of a fractured pelvis. The condition presents with either poor urinary flow, sometimes with a spraying stream, and sometimes urinary infection. Often strictures can be treated endoscopically with a cystoscope (urological operation scope) during which the stricture is dilated or incised to open up the narrowing.
The procedure is performed under general anaesthetic and IV antibiotics are given at the time. Dilation involves passing a thin wire through the stricture into the bladder and then passing gradually larger silicone dilating tubes over the wire through the stricture to gradually enlarge it. Incision of the stricture is done using a small endoscopic knife passed through the cystoscope and this is used to cut the dense scar tissue carefully, thereby opening up the passage.
The procedure lasts about 30min and patients can usually be discharged home the same day. The risks of the procedure include infection, bleeding, pain, and a very small chance of causing leakage if the stricture is at the level of the sphincter muscle responsible for continence.
Often it is necessary to leave a catheter in for several days to prevent immediate re-narrowing of the urethra. The patient is returned to hospital after 5 to 7 days to have the catheter removed by the Day Ward nurses who ensure that the patient is able to urinate well thereafter. Sometimes, if strictures recur, patients are taught how to perform self-dilation of the urethra to keep strictures open and prevent narrowing. This involves passage of a clean, lubricated catheter by the patient into the urethra through the narrowed segment, and this is done 2-3 times per day initially and then gradually tapered down to once a day or a few times a week after some weeks have passed. Our Day Ward or Urology Ward nurses are experienced in teaching patients how to perform these techniques.
In patients with severe recurrent strictures, a more definitive operation may be needed than treatment through a cystoscope. This involved an open operation