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Old 10-31-2011, 10:58 AM   #1
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pgjohnson HB User
urethral stricture surgery question

Hi All,

I am a 36 yr old male. Earlier this year I was diagnosed with a urethral stricture and at the end of July I had a visual internal urethrotomy. Well... the stricture is back and now I have to make a choice as to what surgery I want to have next. I can either have another VIU which the surgeon says will have 50% chance of success in clearing the stricture. Or I can go for a urethral reconstruction which he says will have a 80-90% chance of success. I am a little daunted by the recovery period of the reconstruction but I also like the chance of success much better. I am on the fence as to what I want to do right now.

Any advice or opinions from people who have gone through this would be greatly appreciated!

Thanks,
Paul

 
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Old 03-23-2012, 12:18 PM   #2
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Re: urethral stricture surgery question

Do not believe that 50% cure rate on a repeat urethrotomy. That's not true.

Under ideal conditions, with the nicest possible strictures, you might hope for that on a first urethrotomy, but not a repeat. You've already had recurrence in just a few months; you can't expect repeat urethrotomies to deliver better results.

You might get an 80-90% durable success rate with an anastomotic urethroplasty - simply excising the strictured section, if it's short enough; though having urethrotomies tends to extend the stricture. With substitution procedures, like a buccal mucosa graft, there is an attrition rate over the long term, though still far better long-term success rates than more urethrotomies.

In my own case, after failed urethrotomies, I had urethroplasty with buccal mucosa graft in 2006, on two strictures (the original one, and another one resulting from the previous surgery). Doing well so far.

I am always horrified when I read the experiences of people who keep on having urethrotomies and dilatations over and over again, year in and year out. Personally, I would never go back to that. Even if I do need another procedure in the future, I would absolutely stick with urethroplasty again.

Last edited by Administrator; 03-23-2012 at 03:08 PM.

 
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Old 03-24-2012, 01:24 PM   #3
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Re: urethral stricture surgery question

You will not get 50% chance of cure with a repeat urethrotomy - especially when you've had recurrence in just a few months. A repeat urethrotomy now is a palliative treatment only. I'm not allowed to quote sources in the medical literature here, but believe me, there are lots and lots of them.

Under ideal conditions, with a short (<1cm), superficial, previously untreated, single stricture, located in the bulbar urethra, a urethrotomy might have a 50% chance of cure, though that's somewhat questionable.

If the same stricture had been treated with an anastomotic urethroplasty - excising the strictured section - you might well have an 80-90% chance of cure.

If the stricture is longer (and doing urethrotomies will tend to extend the stricture), urethroplasty might require tissue grafts. This may not give as good a chance for permanent cure, but it still has far better long-term success rates than repeat urethrotomy.

In my own case, after failed urethrotomies, I had urethroplasty with buccal mucosa graft in 2006, on two strictures (the original one, and another one resulting from the previous surgery). Doing well so far.

I am always horrified when I read the experiences of people who keep on having urethrotomies and dilatations over and over again, year after year. Personally, I would never go back to that. Even if I do need another procedure in the future, I would absolutely stick with urethroplasty again.

 
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