A urethral stricture is a narrowing of the urethra caused by scar tissue. As the scar tightens, the urine stream weakens, the bladder has to work harder, and infections, incomplete emptying, and eventually bladder damage can follow.
What causes a urethral stricture?
Strictures form wherever the urethral lining has been injured and healed with scar. The most common causes are:
- Instrumentation and catheters — prior surgery, prolonged catheter use, or endoscopic procedures
- Trauma — straddle injuries, pelvic fracture with urethral disruption
- Inflammatory conditions — lichen sclerosus (balanitis xerotica obliterans)
- Infection — particularly untreated urethritis
- Idiopathic — a substantial share have no identifiable cause
Symptoms
- Weak, split, or spraying stream
- Straining to urinate; a sense of incomplete emptying
- Frequency, urgency, or getting up at night
- Recurrent urinary tract infections or epididymitis
- Urinary retention — sometimes the first sign
Why dilation and DVIU often fail
Dilation and direct vision internal urethrotomy (DVIU) stretch or cut the scar open. They are quick and minimally invasive, and for a short, first-time stricture they are a reasonable attempt. But they do not remove the scar — and cutting scar tissue provokes the body to lay down more of it.
Published long-term data consistently show that success falls sharply with each attempt: a first DVIU has a meaningful chance of durable success in carefully selected short strictures, while repeat procedures approach a near-zero long-term cure rate. Many men end up in a cycle of dilation every few months for years.
The practical takeaway
If you have needed more than one dilation, additional dilations are unlikely to solve the problem. That is the point at which a reconstructive evaluation is worthwhile — not after years of repeat procedures and further scarring.
What is urethroplasty?
Urethroplasty is open surgical reconstruction of the urethra. Rather than stretching the scar, the surgeon removes or bypasses it and rebuilds a normal-caliber channel. The technique is chosen based on the stricture's location, length, and cause:
| Technique | Typically used for | What is done |
|---|---|---|
| Excision and primary anastomosis (EPA) | Short bulbar strictures, usually under ~2 cm | The scarred segment is cut out and the healthy ends are sewn together |
| Buccal mucosa graft urethroplasty | Longer strictures, or where excision would cause tension | A graft of cheek lining is used to widen the urethra; buccal tissue tolerates a wet environment well |
| Flap urethroplasty | Selected penile or complex strictures | Local skin with its own blood supply is transferred to rebuild the channel |
| Staged urethroplasty | Severe, recurrent, or lichen sclerosus–related disease | Reconstruction is completed in two operations several months apart |
Success rates
In experienced hands, urethroplasty is among the more durable operations in urology. Contemporary series report long-term success in roughly the 85–95% range for bulbar strictures, with excision and primary anastomosis at the higher end of that range and graft-based repairs somewhat below it. Success depends heavily on stricture length, location, cause, and prior treatment — men with lichen sclerosus or multiple prior failed repairs have lower rates.
These are published population figures, not a promise about any individual case. What they establish is the general principle: a properly selected urethroplasty is far more durable than repeat dilation.
Recovery
- Hospital stay: most urethroplasties are same-day or one overnight
- Catheter: typically around two to three weeks, removed after an imaging study confirms healing
- Return to desk work: often within one to two weeks
- Heavy activity and cycling: usually restricted for four to six weeks
- Buccal graft donor site: soreness and altered sensation for a couple of weeks; a soft diet initially
Redo and complex cases
A failed prior repair does not mean nothing more can be done. Redo urethroplasty, staged reconstruction, and substitution techniques exist precisely for these situations. If you have been told your stricture is not reconstructable, a second opinion from a surgeon who performs complex and redo repairs is reasonable before accepting lifelong catheterization or a permanent diversion.
Common questions
Is urethroplasty a permanent fix?
For most patients it is intended as a one-time, definitive repair rather than a temporary measure. Published long-term success runs roughly 85–95% for bulbar strictures in experienced hands. Recurrence is possible, and it is more likely with long strictures, lichen sclerosus, or multiple prior failed treatments.
How is urethroplasty different from dilation?
Dilation stretches the scar open; the scar remains and typically tightens again. Urethroplasty removes or bypasses the scar and rebuilds a normal channel. Dilation is quick but temporary; urethroplasty is a larger operation with a far more durable result.
How many dilations should I have before considering surgery?
If a stricture has recurred after one dilation or urethrotomy, the odds that another one will provide a lasting cure are low. Most reconstructive urologists suggest evaluating for urethroplasty at that point rather than continuing a cycle of repeat procedures, each of which adds scar tissue.
Will urethroplasty affect erections or ejaculation?
Most men do not have a lasting change in erectile function. Temporary changes in sensation, erections, or the force of ejaculation can occur in the early recovery period and usually improve. The risk profile varies by technique and stricture location, and it should be discussed specifically for your anatomy before surgery.
How long will I have a catheter?
Typically about two to three weeks. Before removal, an imaging study (a pericatheter urethrogram) is usually done to confirm the repair has sealed.
What is buccal mucosa and why is it used?
Buccal mucosa is the lining of the inner cheek. It is used as a graft because it is thin, has a rich blood supply, tolerates a constantly wet environment, and heals well at the donor site — qualities that make it well suited to rebuilding the urethra.
Can a stricture come back after urethroplasty?
It can, though most recurrences appear within the first few years. Long-term follow-up with symptom checks and flow measurement is standard so that any narrowing is identified early, when it is easier to address.
Related procedures
Discuss your options with Dr. Azad
Referrals are welcome but not required. Bring any records from prior procedures — operative notes, imaging, or urethrograms — and we will review them together.
504-988-5271Dr. Babak Azad — Reconstructive Urology, Metairie & New Orleans, LA