Cared for by Dr William Akakpo
A urethral stricture is a scarred narrowing of the urinary channel. Scar tissue gradually restricts the flow of urine, and because the bladder has to work harder to empty, symptoms often appear slowly over months or years. Strictures may follow an infection, an injury, catheter or endoscopic trauma, radiotherapy or lichen sclerosus, and in some men no cause is ever found. Repeated dilatation or internal incision may relieve symptoms for a while, but the stricture usually returns; open reconstruction offers a durable, one-time repair in the large majority of cases.
A thin graft is harvested from the inside of the cheek and used to widen the narrowed segment. Cheek lining tolerates urine remarkably well, heals quickly and leaves no visible scar. This is the reference technique for longer strictures of the bulbar or penile urethra, with long-term success rates above 90% in experienced hands.
For short bulbar strictures, the diseased segment is completely removed and the healthy ends are joined. Because no scar tissue is left behind, this is the most durable of all repairs.
Complex, long or recurrent strictures — particularly after lichen sclerosus, failed hypospadias surgery or pelvic trauma — may require penile skin flaps or a two-stage reconstruction, planned and discussed in detail beforehand.
Patients who have already undergone dilatation, urethrotomy or a previous urethroplasty are a substantial part of the practice. The whole urethra is re-assessed from scratch before a revision plan is proposed.
Dilatation and internal urethrotomy stretch or cut the scar without removing it. They can help in the short term, but recurrence rates after repeated procedures exceed 80%, and each attempt adds scar tissue that makes definitive reconstruction harder.
The donor site heals within two weeks. Eating is slightly uncomfortable for a few days; long-term numbness or tightness is rare when the harvest is done carefully.
Erectile function is preserved in the vast majority of cases. Some men notice a temporary change in the force of ejaculation, which usually settles over the first months.