Urethral Stricture After Stent Placement: Concerns and Treatments

Q: Urethral Stricture After Stent Placement: Concerns and Treatments

Hello Mr. <br>Marco： Based on your description, you have undergone stent placement surgery for traumatic urethral stricture and initially experienced smooth urination. <br>However, your urine stream later became thin and weak. <br>The most common cause of this is the proliferatio

Traumatic urethral stricture (after stent dilation)

Hello Dr.
Lin, I previously inquired about traumatic urethral stricture, particularly membranous urethral stricture near the sphincter.
I have undergone surgery in Kaohsiung for stent placement and dilation, and it has been over two months since the procedure.
Initially, the results were quite good, and I was pleased that this significant expense was worthwhile.
However, about a week ago, I started to feel a sense of weakness during urination.
Upon observing the urine stream, I noticed it has become thinner than before, and when standing to urinate, I often dribble onto my pants.
I am very concerned that the stricture site may have recurred through the mesh gaps of the stent.

I would like to ask about my situation, which seems similar to that of a fellow patient I previously consulted with, who also underwent multiple anesthesia procedures for direct vision incision of the stricture.
Would it be appropriate for me to consider laser treatment? Additionally, could you explain what steroid injections entail as a treatment option? What are the potential impacts on the body from the injection site? Are there any medications available that could improve conditions for patients like us who suffer from traumatic urethral stricture due to anatomical predispositions?

Marco, 20~29 year old female. Ask Date: 2003/12/24

Dr. Lin Hexing reply Urology

Hello Mr.
Marco: Based on your description, you have undergone stent placement surgery for traumatic urethral stricture and initially experienced smooth urination.
However, your urine stream later became thin and weak.
The most common cause of this is the proliferation of endothelial tissue growing in the mesh gaps of the stent, leading to urethral obstruction.
A follow-up urethroscopy should clarify whether this is the underlying issue or if there are other causes of stricture.
Of course, the aforementioned problem can be addressed endoscopically by using a resectoscope or laser to remove the proliferative tissue.
Steroid injections can be administered under direct vision during the urethroscopy when re-opening the stricture, and they have shown some efficacy in preventing the regeneration and proliferation of scar tissue.
However, there is currently no large-scale clinical evidence to strongly support its effectiveness, and it is not commonly used in practice.
At present, there are no medications available to improve the condition of traumatic urethral stricture.
We hope that advancements in medicine will lead to the development of drugs that can alleviate the severity of post-traumatic urethral stricture, which would greatly benefit the public.

Reply Date: 2003/12/24

More Info

Urethral stricture, particularly after stent placement, can be a concerning issue for many patients. Your experience of feeling a decrease in urinary stream and the sensation of urinary urgency or incontinence is not uncommon, especially after undergoing a procedure for urethral stricture. It’s important to understand the potential causes and treatment options available for your situation.

Firstly, the narrowing of the urethra, or stricture, can indeed recur even after successful stent placement. The stent is designed to keep the urethra open, but over time, scar tissue can form around the stent, leading to a re-narrowing of the urethra. This is particularly true in cases of traumatic injury to the urethra, such as what you described. The fact that you are experiencing a weaker urinary stream and dribbling suggests that there may be some degree of re-stricture occurring.

In terms of treatment options, if you are concerned that the stricture is returning, it is crucial to consult with your urologist. They may recommend a urethral dilation or a repeat urethrotomy, which is a surgical procedure to cut the stricture. Laser treatments, such as laser urethrotomy, can also be effective in treating strictures, especially if they are located in areas that are difficult to access surgically. This method uses laser energy to precisely cut the scar tissue causing the stricture, allowing for a wider urethral passage.

Regarding the use of steroids, steroid injections can be used to reduce inflammation and scarring in the urethra. This treatment is typically administered directly into the area of the stricture, and it can help to prevent or slow the formation of scar tissue. The effects of steroid injections can vary, and while they can be beneficial, they also come with potential side effects, such as increased risk of infection or tissue weakening.

As for medications, there are no specific drugs that can reverse urethral strictures, but some medications may help manage symptoms or reduce inflammation. Your urologist may consider prescribing medications that can help with urinary flow or bladder function, depending on your specific symptoms.

It’s also important to maintain regular follow-ups with your healthcare provider to monitor the condition of your urethra after stent placement. They may perform periodic urethral assessments, such as cystoscopy, to visually inspect the urethra and determine if there are any signs of re-stricture.

In summary, your concerns about the recurrence of urethral stricture after stent placement are valid, and it is essential to address these issues with your urologist. They can provide a tailored treatment plan based on the severity of your symptoms and the findings from any diagnostic tests. Early intervention can often lead to better outcomes, so don’t hesitate to reach out for further evaluation and management.

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