Michael Metro, MD, Director of Reconstructive Urology at Temple University Hospital, explains the symptoms and causes of urethral strictures -- a narrowing of the urethra, most typically within the area underneath the scrotum -- and how they are diagnosed and treated at Temple.
I'm Doctor Michael Metro and I'm the director of traumatic and reconstructive urology here at Temple University Hospital. The typical patient for me and someone that does uh male reconstructive urology is a urethral structure which is a narrowing of the tube that drains the urine from the bladder and into the toilet bowl. It can be on in a variety of areas of the urethra, but most of them are in the portion of the urethra called the bulbar urethra which is underneath the scrotum actually. Uh and that area of the urethra can get narrowed from trauma even when someone was a kid fell on his bike, got kicked under the S T or more acutely like a traumatic injury that we might see in the emergency room. And the result is a narrowing of the urinary stream which sounds horrible, but it can be, it can be subtle until it really becomes bad and then the patient comes in with the inability to urinate or urinary tract infections and affects their quality of life. There are some non invasive studies that you can do. There's a study called a flow meter where a patient voids into this funnel and measures how fast and also which is the curve like how fast they're going at a particular time. We can also measure how they're emptying their bladder with an ultrasound. And those non invasive flow tests and an ultrasound test are things that can be done without touching the patient that clue me into something that's going wrong. And then ultimately, it's an X ray study called a urethra gram where it's a fast test that can be done as an outpatient squirting some contrast, eye in through the penis and taking a picture. And it shows a clear outline of where the normal urethra is and where a narrowing or the structured part of the urethra is. And then looking in with the telescope is always a quick way to say you got a problem. We need to do an X ray. In the past urologists used to temporize these patients by stretching their structure or going in with the telescope and cutting the structure and letting it heal over a catheter that's placed into the penis and bladder. Now that always mostly works short term. But the long term success of that intervention is very low in 2002. And beyond the school of thought has changed to treating these patients definitively with a little more complex procedure up front. And so instead of a 30 minute outpatient procedure, this is a two or three hour one night in the hospital inpatient procedure. But the success rates which sometimes are 0% for a dilation. Long term are over 90% for a general reconstructive logic procedure based on the length of the structure, we have two options. One is you have a short structure which is less than two centimeters or so, you can actually cut that segment of urethra out and the urethra is elastic enough to sew back together again. And that's called an anastomotic urethroplasty. And that's the gold standard. That success rate is over 95% with a two or three hour operation. And instead of coming back every three months, six months or six weeks, the patient just comes in for doing ok. And then they get to go on with their life and not worry about it. If the structure is longer or in a different area of the urethra, I use what's called a substitution urethroplasty where I might use some skin from the inside of the cheek or genital skin to fix and make the urethra bigger. And that adds a little more complexity to the surgery, but it does not change the success rate significantly. And nor does it change the recovery period significantly.
