Exploring Treatment Options for Urethral Stricture After Injury

Urinary issues?

Hello Director Lin, I am Hong Ronghua, living in Kaohsiung.
On May 26 of last year, I suffered a closed pelvic fracture and urethral rupture due to a car accident on my way home from work.
I was taken to Kaohsiung Veterans General Hospital, where the treatment involved placing a urinary catheter to allow the tissue to heal on its own.
After a long treatment process, I began attempting to remove the catheter and urinate independently starting October 11 of last year.
It has now been over ten months, but I have repeatedly faced issues with urethral stricture, resulting in numerous emergency surgeries for incision.
Later, I transferred to Xiaogang Hospital, where the attending physician performed four dilation procedures and three incision surgeries, but the results have not been satisfactory.
Additionally, I learned from the doctor that the length of my stricture is about 1.5 cm, with only 1 cm from the external sphincter being at the membranous urethra.
The doctor suggested placing a titanium alloy urethral stent, but there are risks involved.
I would like to ask Director Lin if there are any other treatment options available for cases like mine, aside from the placement of a urethral stent?

Hong, 20~29 year old female. Ask Date: 2003/09/09

Dr. Lin Hexing reply Urology

Dear Mr.
Hong Ronghua,
Regarding the urethral injury you have encountered, which has resulted in a long segment stricture, this is indeed a challenging issue.
Traditionally, the treatment for urethral stricture has primarily involved dilation or incision procedures; however, in your case, these methods may not yield the desired results.

In addition to titanium alloy urethral stents, you may also consider laser urethrotomy or urethroplasty.
For laser urethrotomy, there is a facility at the Taichung area, specifically at the Taichung City Hospital Fengyuan Branch, where you can inquire about their experience by calling 0425271180 ext.
1100.

As for urethroplasty, this surgical approach involves excising the stricture segment and anastomosing the healthy ends, which is a good treatment option for posterior urethral strictures (membranous urethra) caused by pelvic fractures.

Reply Date: 2003/09/09

More Info

Dear 洪榮華,
Thank you for reaching out regarding your ongoing challenges with urethral stricture following your traumatic injury. Urethral stricture can be a complex condition, particularly after a significant injury such as a pelvic fracture with associated urethral damage. Your experience with multiple procedures, including dilation and incision, highlights the difficulties many patients face in managing this condition.

Urethral stricture occurs when the urethra narrows, which can lead to various urinary symptoms, including difficulty urinating, urinary retention, and recurrent urinary tract infections. Given your history of repeated interventions, it is understandable that you are seeking additional treatment options beyond the proposed titanium alloy stent.

1. Urethroplasty: This is often considered the gold standard for treating urethral strictures, especially in cases where the stricture is longer than 1 cm. Urethroplasty involves the surgical removal of the narrowed segment of the urethra, followed by reconstruction using tissue from the surrounding area or a graft. This procedure has a high success rate and can provide long-term relief from stricture symptoms.

2. Buccal Mucosa Grafting: If the stricture is extensive or located in a challenging area, a buccal mucosa graft may be utilized. This involves harvesting tissue from the inside of your cheek to reconstruct the urethra. This technique can be particularly beneficial for strictures that are difficult to manage with standard urethroplasty.

3. Endoscopic Techniques: While you have already undergone several dilations and incisions, some patients benefit from newer endoscopic techniques such as laser urethrotomy. This method uses laser energy to cut through the stricture, potentially providing relief with less trauma than traditional surgical methods. However, the long-term success rates can vary.

4. Self-Catheterization: In some cases, patients may be advised to perform intermittent self-catheterization to help maintain urethral patency. This approach can help prevent the stricture from worsening and may reduce the frequency of urinary retention episodes.

5. Stent Placement: As you mentioned, the placement of a titanium alloy stent is an option. While it can provide immediate relief, there are risks associated with stenting, including infection, migration of the stent, and potential discomfort. It is essential to weigh these risks against the potential benefits.

6. Regular Follow-Up: Regardless of the treatment option you choose, regular follow-up with your urologist is crucial. Monitoring the stricture's status and any urinary symptoms can help guide further interventions if necessary.

7. Multidisciplinary Approach: Sometimes, involving a multidisciplinary team, including urologists, pelvic floor specialists, and physical therapists, can provide a more comprehensive approach to managing your symptoms and improving your quality of life.

In conclusion, while the titanium stent is one option, you may want to discuss the possibility of urethroplasty or buccal mucosa grafting with your urologist, especially given the length and location of your stricture. Each case is unique, and the best treatment plan should be tailored to your specific situation, taking into account your medical history, the characteristics of the stricture, and your personal preferences.

I hope this information helps you in your discussions with your healthcare provider. Please feel free to reach out if you have further questions or need additional clarification.

Best wishes for your recovery,
Doctor Q&A Teams

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