Drug treatment has no place in the treatment of urethral stenosis. In the treatment of urethral stenosis, there are two types of surgical methods: endoscopic closed method in which the stenosis is opened by cutting (urethrotomy intern) and open surgery (urethroplasty). The treatment method to be selected depends on the cause, location, length and severity of the stenosis.
Patients who are suitable for urethroplasty are as follows;
- Patients with recurrent stenosis
- Patients who have undergone more than two closed surgeries and have failed surgery
- Patients with urethral stents implanted and failed
- Patients whose urethra has been severed during an accident
- Patients with recurrent stenosis who underwent radical prostatectomy for prostate cancer
- Patients who had been operated before but had no benefit
- Patients with frequent recurrence
- Patients with stenosis greater than 2 cm
Urethroplasty is the best treatment for urinary tract stenosis. It is the most effective treatment method that provides permanent treatment of stenosis. The basis of surgery is based on the removal of the stenosis area and the suturing the the remaining ends to each other. If the narrow part is too long then it is patched with tissues taken from various places such as mouth mucosa, bladder mucosa or penis skin.
There are different urethroplasty techniques. Urethroplasty operation may take 2-3 hours depending on the method applied. In this surgery, depending on the location of the urinary tract stenosis, the stenosis area in the urinary tract is reached by an incision made from either the lower part of the penis or just below the testicle.
If the length of the stenosis is shorter than 2 cm, this area is removed as is, and the remaining healthy tissues are joined together to form a new urine channel. If the stenosis is longer, this end-to-end method is not applied. In this case, patching is performed on the stenosis region. Penile skin or cheek mucosa is used for the patch. After the operation, the patient remains in the probe for 2-3 weeks.
Some patients have completely closed urine. Stenosis in the urinary tract may not be treated by a single operation in these patients. In those people whose urine canals are completely closed, there is not enough tissue for the patch, if the penis structure is not suitable for patching or there is a risk of anesthesia for long-term surgery, the urethrais temporarily mouthed just below the testicle bag. Six months after this procedure, a new operation is performed to bring this urinary canal to the tip of the penis located in the lower part of the testicle bag. If the patient does not want a second operation, the urine can be left permanently in the lower part of the testicle bag. However, these people cannot urinate by standing andcan urinate only by sitting. The rate of recovery of urethral stenosis with open surgery is 90-95%.