Dear Dr. Motola:
My husband is experiencing problems urinating: pain, blood, pressure, etc. The urologist indicated that his urethra is being blocked by strictures or scar tissue from radiation treatment for prostate cancer. He has had two cystoscopies within a month and a half to stretch the urethra. His last one was this past week and the urologist left a catheter in place until tomorrow (6 days) in hopes that would help keep the urethra open. What would be our next step? We are thinking of urethral reconstruction. We thought about a stent but read that, too, can cause scar tissue to form. Any thoughts or suggestions would be greatly appreciated. Needless to say, he is becoming a little discouraged. We are just looking for a light at the end of the tunnel and some return to normalcy.
Urethral strictures can be very difficult to treat. Patients with severe strictures will commonly require numerous treatments for this problem. The idea of stretching the urethra is a very logical choice, however there is no guarantee that this will be successful.
Although dilation of the stricture is a reasonable approach, transurethral incision of the strictured area (direct vision optical urethrotomy) with either a "cold-sharp knife" or a laser should be the next line of treatment.
If this were to fail, then urethral reconstruction (urethroplasty) would be the treatment of choice. However, the previous radiation that occurred can result in the results of this being suboptimal.