If you have noticed difficulty in passing urine, a painful stream or a thin stream, have urination that stays you up at night, or have that urinating feeling without feeling as though you completely empty the bladder, then this could be a urethral stricture. This condition could be restraining the function of one of the most necessary bodily functions and is one of the most underdiagnosed diseases. This is mainly due to the feeling of embarrassment that most men feel while deciding to seek help.
Urethral stricture provides a lot of that good sustenance and is fully treatable. Especially in Indore, treatments are provided at a city-level metro without the requirement of traveling there.
Dr. Vikas Singh, Senior Consultant Urologist at Kokilaben Dhirubhai Ambani Hospital, Nipania, Indore, has one of the most reconstructive urologists in Central India. He has a lot to offer when in view of urethral stricture treatments. His services include the most advanced Buccal Cell Implant techniques, Open Urethroplasty, and a variety of minimally invasive Laser OIU services. The best treatment is provided by a dedicated team that takes an ample amount of time to understand each patient’s lifestyle goals and aspirations.
If you have lived with this condition in the long term and have been continuously looking for options, then you may have just contacted the right place. We can promise you that you will be extremely satisfied.
The urethra is the tube for urine to exit the bladder. In men, it runs through the prostate and the length of the penis, eventually opening at the tip. In women, it is shorter and opens just at the vaginal opening.
When the urethra is injured, infected, or inflamed (sometimes due to surgery), scar tissue may form in or around the urethra. This causes the urethra to become narrower. The same goes for a kink in a garden hose (the pressure causes the hose to expand, and the flow of water diminishes to a trickle.
Urethral strictures mean urine can’t easily exit the bladder. The bladder must generate more pressure, risking bladder damage, and causing urine to back up in the kidneys, causing infections and damage. (All of this would be a slow process; the damage to the bladder and infection would be one thing.
Urethral strictures are mostly a masculine condition; the diagnosis is possible at any age. from young men expecting to have a pelvic injury to older men expecting to have Prostate surgery or Catheter placement. Urethral Stricture is often compromised or confused with an enlarged prostate, which is why it is very important to seek specialist evaluation.
The most distinctive feature of urethral stricture is recurrence. Once the scar tissue forms, it is tenacious. Lack of treatment may be less than ideal, but the body often heals it without a recurrence. Accordingly, the best procedures and surgeons determine the best results.
Urethral strictures develop when scar tissue forms in the lining or surrounding layers of the urethra. The reasons this happens vary widely from patient to patient.
Here are the most common causes:
Physical trauma is one of the most common causes of urethral stricture, particularly in younger men. A straddle injury – where the perineum (the area between the scrotum and the anus) strikes something hard, such as the bar of a bicycle, a wall, or a fall – can crush the urethra between the pelvic bone and the object, causing scar tissue to form as the injury heals.
Pelvic fractures from road traffic accidents are another major cause. A severe pelvic fracture can tear or completely disrupt the posterior urethra – the portion closest to the bladder – resulting in what is called a pelvic fracture urethral distraction defect (PFUDD), one of the most challenging forms of urethral stricture to treat. Dr. Vikas Singh has experience in managing even these complex cases with reconstructive urethroplasty.
Certain sexually transmitted infections – particularly gonorrhoea – have historically been a leading cause of urethral stricture worldwide. Gonorrhoea causes significant inflammation of the urethral lining, and repeated or inadequately treated infections can result in scarring across long segments of the urethra.
Urinary tract infections (UTIs), particularly recurrent ones, can also cause localised inflammation of the urethra. Lichen sclerosus – a chronic inflammatory skin condition that affects the foreskin and glans of the penis in uncircumcised men – is a particularly stubborn cause of urethral stricture, as it can progressively involve longer and longer segments of the urethra and is prone to recurrence after surgery.
Urethral strictures frequently develop as a complication of medical procedures. The common culprits include:
In a small number of cases, urethral stricture can be congenital – meaning present from birth due to abnormal development of the urethra during foetal development. Congenital strictures are more commonly associated with other urological anomalies. They may not cause significant symptoms until the child grows older or until they are discovered during the investigation of other urinary problems.
A lot of men try to pass off the signs and symptoms of urethral strictures as signs of aging or even possible prostate issues. What most don’t know is that symptoms of urethral strictures become chronic and they can ignore these symptoms for months and even years. The longer they ignore the symptoms and signs of urethral strictures, the more excess scar tissue develops, and complications of treatment occurs and it becomes a lot more complex.
These symptoms of urethral stricture are as follows:
Diagnosis helps establish the foundation of treatment. In order for a patient to receive the most optimal treatment available for their case of urethral stricture, Dr. Singh takes a multi-faceted approach by integrating all functional assessments, imaging studies, and direct visual assessments of a patient’s urethral stricture at Kokilaben Hospital, Indore. This provides the extent, length, and characteristics of the stricture, as well as and other related scarring.
Uroflowmetry is the common non-invasive method of diagnosis to measure the volume and speed of a patient’s urinary output. This is done by having a patient urinate into a funnel that is attached to a urinary output measurement device that shows a graph of their output at the respective time intervals.
An optimal measurement of urinary output for a healthy individual is typically above 15ml/sec and a smooth curve. Urethral stricture is a narrowing of the urethra, and results in a maximum flow rate of typically below 10 ml/second. Uroflowmetry is used by Dr. Singh to attain an objective measurement of the degree of urinary obstruction caused by the stricture, as well as used as a post-measurement to assess the improvement after treatment.
As a component of post-void residual urinary measurement, a urine that remains in the bladder after urinating, above 100 ml, is an indicator high residual urine is that a patient is not emptying their bladder fully.
Retrograde Urethrogram (RGU) is the golden imaging standard test used to evaluate the presence of urethral strictures. During the examination, a contrast dye, which is a type of sensor that shows up in the imagine, is injected in the urethra through the urethral opening (which doesn’t require sedation), and X-rays are taken of the urethra to bladder connection.
RGU is able to show the different levels of exactness of which a stricture straight is and of which strictures are transverse. This is especially critical of a surgical treatment, as it will show the approximate level difference of the stricture. There are cases where strictures of a combined nature, particularly posterior strictures, are partially examined using a Micturating Cystourethrogram (MCU).
In a Cystoscopy, the internal urinary bladder is directly visualized using a thin, flexible camera called a cystoscope, which is to be passed through the urethra. This procedure helps Dr. Vikas Singh assess the internal quality of the urethra and helps him see the stricture adequately. It in return accommodates him enabling him to evaluate the secondary changes of the bladder which aids him as he can see trabeculation stones which are critical to bladder, and helps him decide the surgical procedure.
In several circumferences, a local anaesthetic gel is applied in order to relax the urethral opening, and diagnostic cystoscopy is performed as an outpatient procedure. In several cases of complete or nearly complete obstruction, the scope is unable to pass through the stricture and provides direct valuable information of the type of restriction.
Instead of using radiation, urethral ultrasound (sonourethrography) can evaluate the length of the stricture, and the degree of spongiofibrosis. Spongiofibrosis surround the spongy (corpus spongiosum) tissue of the penis. Higher spongiofibrosis implies a more complex stricture. Because of this, a urethroplasty that is an endoscopic procedure is less likely.
A renal ultrasound (kidneys plus bladder) (KUB) is performed routinely, and checks for complications (from stricture) like bladder wall thickening, hydronephrosis, and bladder calculi.
MRI of the pelvis will capture gaps and the length of the broken urethra. It is valuable for the complex posterior urethral strictures, especially those that fracture the pelvis. It shows the surrounding soft tissue and aids in the preparation of the surgery.
Urethral strictures by nature vary in many aspects. Different things are factored when deciding which treatment to use. Amongst these are the length of the stricture, location, is it a recurrent or newly occurred stricture, surrounding tissues with scarring, and the general wellbeing of the individual or their preferences. As an example, Dr, Vikas is available to carry out all of the degrees of cases, regardless of which of the more advanced of the complicated stricture treatments, and through the use of both modern and non-modern urethral stricture treatment options at Kokilaben Hospital Indore..
Surgical Reconstruction of the Urethra, or Urethroplasty for short, is the most proven of urethra stricture surgical treatments, as well as being the most successful. Comparing OIU to Urethroplasty, OIU would probably be considered the least complex, and for the patient who desires the urethra stricture to be treated in his or her long, complex, and recurring stricture, Urethroplasty would be considered the most complex.
The general public knows of the routine and common procedure used to treat urethral stricture as the Optical Internal Urethrotomy and or the Optical Internal Urethrotomy. The procedure assures most patients they will be home the same time the next day, given that it’s a same day and incisional, minor, and quick.
When an OIU is done, a cystoscope is strategically placed to dilate the stricture when using a thin blade. The blade is placed through the urethra to create a passage (or urethrotomy), through the stricture, and to ensure that normal urinary flow is not disrupted. The precision of the LASER OIU surpasses that of the traditional cold knife OIU and lessens collateral thermal injury.
OIU works best for:
One thing to take into account for OIU is recurrence. Research shows the long-term success rate of OIU for strictures that are longer than short, primary strictures is only 30 to 50% due to the majority of strictures recidivating within 1 to 3 years. OIU is not meant to be a long-term treatment for morbidity caused due to stricture recurrence, and Dr. Vikas Singh openly addresses this with every patient.
Urethroplasty requires a hospital stay of 3 – 5 days. You will also require a catheter for 3 – 4 weeks. Recovery takes 4 – 6 weeks when normal activities can be resumed. The long-term success buccal mucosa urethroplasty achieved at experienced centres is around 85 – 92%.
AALBEC, or Autologous Adult Live Cultured Buccal Epithelial Cells, is pioneering the field of urethral stricture disease management. Dr. Vikas Singh is one of the few surgeons in India who offers this technique.
AALBEC combines minimally invasive surgeries, such as endoscopy, with regenerative medicine. Live epithelial cells cultured in a lab are supplemented using a small mucosal sample from the inner cheek. Subsequently, these autologous live buccal cells are endoscopically introduced to the urethral stricture site. Before the introduction of these live cells, an Optimum Internal Urethrotomy or OIU had to be performed to stricture the site.
It is hypothesized that autologous buccal cells, are able to engraft, proliferate, and regenerate a healthy urethral lining from the surgical site. By providing live tissue to the site, scar tissue and stricture recurrence are delayed or prevented.
Key advantages of AALBEC:
AALBEC should be prioritized for patients with primary or our recurrent Bulbar strictures, and patients with medical conditions that make other forms of open urethroplasty riskier. Clinical studies that compare AALBEC to OIU have noted better outcomes among patients with AALBEC. Success rates, UFR, and symptom scores have been observed to be better, and have subsequently noted improvement.
Based on an extensive evaluation, Dr. Vikas Singh will inform you on the factors of your stricture whether AALBEC will be fitting. The factors will be the length, location, and the history of prior treatments.
The process of dilatation involves increasing the size of the urethra. In this process, the urethra is stretched by using instruments of increasing size (dilators or sounds) which are inserted through the urethra. Being the oldest method of treating urethral stricture, this method provides symptomatic relief in the short-term. However, in the long run, this is not a None of the symptoms associated with this condition are addressed because the cause of the problem does not disappear or is addressed.
Woefully enough, the spongiofibrosis, which is the primary erectile tissue of the urethra, is negatively impacted the most by this repeated dilatation. Therefore, we can deduce that the increased dilation of the urethra significantly increases the incidence of severe trauma to the urethra. Additionally, this increases the severity of the condition.
The modern practice of urology dictates that dilatation should be done with the utmost caution. In general, dilatation should only be practiced to a)
Temporary relief of sudden urinating problems while preparing for a permanent solution.
Patients with multiple chronic problems, especially older patients and those would not fare well post-operatively.
A program for patients that require self-dilatation or self- catheterization when they have undergone a urethroplasty, which is the process of removing a segment of the urethra and then rejoining the healthy urethra.
Great care should be taken when deciding on the treatment option for urethral stricture. The table below provides a rough guide for you to compare the options – however the ultimate recommendation will be made after a personal assessment with Dr. Vikas Singh and consideration of your overall clinical scenario.
Factor | OIU / Laser OIU | Urethroplasty | AALBEC |
Best For | Short (<2 cm), primary bulbar strictures | Long, complex, or recurrent strictures | Primary/first-recurrence bulbar strictures, avoiding open surgery |
Procedure Type | Endoscopic – no incision | Open surgery – perineal incision | Endoscopic – no incision |
Success Rate | 30–50% long-term (recurrence is common) | 85–92% long-term (most durable) | Promising medium-term; ongoing research |
Hospital Stay | 1–2 days | 3–5 days | 1–2 days |
Recovery Time | 1–2 weeks | 4–6 weeks | 1–2 weeks |
Catheter Duration | 2–5 days post-op | 3–4 weeks post-op | 5–7 days post-op |
Recurrence Risk | High (especially if stricture is long or recurrent) | Low (especially anastomotic repair) | Lower than OIU alone; data emerging |
Every patient should understand the consequences following the surgery. For your reference, this is a simplified step-by-step recuperation process for planned procedures:
Urinary catheters post surgery are expected to be in place for an approximate threshold of 3 to 5 weeks. Promotion of light work resumption is expected in a 6 to 8 week fn. avoid sexual intercourse for the same duration.
Urinary catheters are expected to be removed post 3 to 5 days. 3 to 5 days is the threshold for urinary comfort post surgery, and 2 to 5 day are the limits for hospital stays. Promotion of light work resumption is expected in a 3 to 5 day timeframe. 2 to 4 week post-operative care recommendations include the avoidance of strenuous/work related activities, as well sexual intercourse. Uroflowmetry is to be done within 3 to 6 month post procedure.
Urinary catheters are post surgery are expected to be in place for a 3 to 5 day time threshold. 1 to 2 weeks for the resumption of light work. Uroflowmetry and cell engraftment are to be expected to be test ed at 3 to 6 month intervals post surgery
Yes. Urethral strictures are commonly known to recur. This is especially the case for endoscopic procedures, such as OIU, because the actual problem (the formation of scar tissue) is not fully resolved. Nevertheless, the likelihood of recurrence can be reduced with appropriate treatment, constant monitoring, and the instillation of a few lifestyle changes.
Lifestyle changes that protect the urethra in the long-term are as follows:
Urethral strictures -especially those with complications including complexity, recurrency, and those that result from trauma- present a challenging reconstruction problem. Dr. Singh’s Urology specialization blends technical prowess and clinical acumen that makes him an excellent surgeon. Below are the reasons that make Dr. Singh an excellent Urology practitioner:
Yes, urethral strictures can be cured. This condition can be permanently resolved on the condition of the deployment of effective and appropriate surgical intervention. Currently, Urethroplasty, and more specifically, anastomotic urethroplasty for short strictures, has a surgical success rate of more than 90%. Even with longer and more complex strictures, a buccal mucosa graft urethroplasty, can be successful and has positive outcomes with the majority of patients. The secret is to use the best surgical solution for the best surgical stricture.
Whether you are having an OIU, AALBEC, or urethroplasty, Urethral stricture surgery is done under anaesthesia. As a result, during the surgery, you will be unaware. After the surgery, many patients experience pain that is rated as mild to moderate for a short period of time, and is easily treated with the normal analgesics that are available. In terms of recovery, OIU takes about 1 to 2 weeks, while urethroplasty can take 4 to 6 weeks and is still a longer recovery process. However, in general, most patients, are of the opinion that the process is much more bearable than they anticipated.
Urethral stricture surgery is not permanent, and more importantly, it very rarely makes sexual function more difficult. There is little to no impact to sexual function while performing the Laser OIU and AALBEC. There is a slight risk of temporary erectile dysfunction with posterior or complex urethroplasty near the prostate. However, this process does improve with time. Dr. Vikas Singh will explain the specific risks for your case during the consultation and will use nerve-sparing methods whenever possible.
It primarily depends on the location, length, and the patient history involved. For the most part, short primary bulbar strictures can be managed with adjunctive AALBEC or OIU. Complex, recurrent, or long strictures should be managed with urethroplasty for long-term solutions. Dr. Vikas Singh will be able to provide personalized recommendations once the findings of your urethrogram, cystoscopy, and uroflowmetry have been assessed.
For short strictures, anastomotic urethroplasty (the end-to-end type) has a 90% success rate and can be considered good at the long-term outcome. For the extended strictures, the successional rate for buccal mucosa graft urethroplasty is often cited between 5.8 and 9.2 and is most commonly observed at the fifth year for those medical facilities where skilled practitioners can be found. This is a vast improvement over the outcomes most strictures achieve with OIU.
AALBEC (Autologous Adult Live Cultured Buccal Epithelial Cells) is a newer, more modern endoscopic method that requires the use of the patient’s own live buccal cells, which are obtained from the inner lining of the cheek, indirectly processed, and subsequently placed at the site of the urethrotomy after the Laser OIU. This is aimed at stimulating the site to produce the proper structural support overgrowth of tissue, which moderates the effects of stricture. Indore has AALBEC, and it can be performed by Dr. Vikas Singh at Kokilaben Dhirubhai Ambani Hospital. For those patients who are ideal for the procedure and wish to avoid an open surgical procedure, it is one of the most advanced procedure options.
The catheter after Laser OIU is left in about 2-5 days, 5-7 days after AALBEC, and up to about a month after urethroplasty. This is to help heal the urethra after the surgery, as the catheter must remain in the body during the healing process. Existing patients can ask Dr. Vikas Singh at the beginning of the surgery to further explain durations of catheter use.
Yes, but unlike OIU, urethral stricture after a urethroplasty is significantly less common. For strictures that require short strictures, the recurrence rate is less than 10%. For strictures that require a buccal mucosa graft urethroplasty, the recurrence rate at about 5 years is between 8 to 15%. If recurrence of the strictures does occur, regular check-ups with uroflowmetry will help identify them the fastest and will allow the fastest action to be taken.
Yes, but it is very rare for women to be diagnosed with strictures than it is for men. Women with urethral strictures may have weak urinary tract flow, painful urges to urinate, and may have a lot of urinary tract infections. This can be a result of surgery done to the pelvis, trauma caused to the urinary tract by a catheter, burns, and radiation. An example of the surgery is a confronted buccal mucosa graft urethroplasty that is done on females with urethral strictures. Dr. Vikas Singh. does address and help with females with urethral strictures as well.
Call at +91 81468 73931 or go to Kokilaben Dhirubhai Ambani Hospital, No. 1, BCM Estate, Nipania, Indore, Madhya Pradesh 452010. Please provide the previous investigation reports and show the videos on uroflowmetry, images of the urethrogram, or reports of the cystoscopy. If you underwent urethral stricture surgery in the past, the reports regarding the previous surgery are valuable in designing the optimal approach to your surgery.
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