What is Urethral Stricture and Why Does It Occur?
Urethral stricture is the narrowing of the urethra, the tube that drains urine from the bladder out of the body. This narrowing restricts urine flow, leading to difficulty urinating and incomplete bladder emptying. The primary cause is scar tissue formation, typically resulting from trauma, urinary tract infections, catheter insertions, or prior urological procedures.
What is Closed Urethral Surgery (Internal Urethrotomy)?
Closed urethral stricture surgery, medically termed "internal urethrotomy", is a procedure performed using a cold knife or laser. Without making any external incisions, the surgeon accesses the narrowed segment of the urethra using specialized optical instruments (cystoscope) and cuts the scar tissue to widen the channel. This minimal invasive option is widely preferred in modern urology clinics in Adana.
Surgical Process and Techniques
The closed surgery is usually performed under general or spinal anesthesia. The main steps of the procedure include:
- Endoscopic Visualization: A camera-equipped scope is inserted into the urethra to locate and examine the stricture.
- Incising the Stricture (Sachse Method): The scarred tissue is carefully incised, typically at the 12 o'clock position, using a cold knife or laser (such as Holmium laser).
- Catheterization: A temporary urinary catheter is placed to keep the channel open and facilitate proper healing of the tissue.
Advantages of Closed Urethral Surgery
Compared to open surgical techniques, internal urethrotomy offers several distinct advantages:
- No external incisions or sutures are required.
- Shorter hospital stay, with most patients discharged on the same or next day.
- Faster and relatively painless recovery period.
- Quick return to daily activities and work.
Recovery and Postoperative Care
The urinary catheter remains in place for 3 to 7 days, depending on the length of the stricture and individual patient healing. After catheter removal, the patient's urine flow rate is assessed. Drinking plenty of fluids, avoiding heavy lifting, and taking prescribed antibiotics and pain relievers as directed are essential for optimal recovery.
Recurrence Risk and Follow-Up
One of the primary considerations after closed urethral surgery is the risk of recurrence (relapse). While success rates are high for short and superficial strictures, longer or deeper scars may recur. In recurrent cases, treatments such as self-dilatation, drug-coated balloons, or open reconstructive surgery (urethroplasty) are considered. Regular follow-up appointments are crucial to monitor long-term success.