Disease Name Confirmation
- Urethral stricture is the medically accurate term.
1) Disease Description (Causes and Symptoms)
- Definition and pathophysiology: Urethral stricture is a condition in which fibrosis of the urethral mucosa and surrounding tissues narrows the urethral lumen, obstructing the passage of urine. Depending on the location of the stricture, it is classified as anterior urethral stricture (penile or bulbar urethra) or posterior urethral stricture (prostatic or membranous urethra). The length of the lesion and degree of fibrosis affect the prognosis.
- Main causes: Congenital (rare), trauma (pelvic fracture, straddle injury), infectious inflammation (such as gonorrhea), prolonged catheterization or transurethral procedures (iatrogenic injury), compression by surrounding tumors, etc.
- Main symptoms: A weak or spraying urinary stream, delayed urination, a feeling of incomplete bladder emptying after urination, increased urinary frequency or urgency, recurrent urinary tract infections, urinary retention (rarely acute obstruction), dysuria, or pelvic pain. In severe cases, impaired kidney function may also occur (in cases of ascending obstruction).
2) Treatment Methods
- Initial and emergency care
- In cases of acute urinary retention, temporary catheterization may be performed (if urethral catheterization is not possible, a trans... (urethroscope) or a urinary diversion into the bladder (suprapubic catheter) may be inserted). Antibiotic treatment is administered concurrently if there is an infection.
- Conservative/medical treatment
- Antibiotics (when an infection is present), improving urination habits (adequate fluid intake and regularizing urination), etc. It is difficult to fundamentally treat the stricture with these measures alone.
- Procedural treatment
- Urethral dilation: Balloon or tube dilation. It is simple, but the recurrence rate is high (especially with repeated procedures, as effectiveness decreases).
- Direct vision internal urethrotomy (DVIU, internal urethrotomy): Used for initial strictures that are short and have limited local fibrosis. The recurrence rate is high, so frequent repeat procedures may be necessary.
- Surgical treatment (urethroplasty)
- Excision and Primary Anastomosis (EPA): Usually shows a high success rate (80–95%) for short bulbar urethral strictures (generally 1–2 cm or less).
- Substitution urethroplasty: For long strictures or tissue defects, a buccal mucosa graft (from the inside of the cheek) may be used. The success rate varies depending on the characteristics of the lesion, but is generally superior to endoscopic treatment.
- Staged repair: Applied in cases of severe tissue damage or inflammation.
- Principles for selecting treatment
- Short, first-occurrence stricture: Endoscopic treatment (dilation or DVIU) may be considered.
- Recurrent or long, fibrotic stricture: Urethroplasty (often recommended as a one-time definitive treatment).
- Follow-up and rehabilitation
- Postoperative catheterization period (usually 1–3 weeks), followed by uroflowmetry, post-void residual urine testing, and, if necessary, imaging (retrograde urethrography/voiding cystourethrography). Sexual and urinary function should be assessed.
- Complications and precautions
- Repeated endoscopic treatment increases the failure rate. Infection, urinary tract injury, urinary diversion, erectile dysfunction, and ejaculatory dysfunction may occur. Consultation with an experienced urologist is recommended.
3) Outpatient Visit Checkpoints (Items to Bring and Example Questions)
- Items to bring
- A list of currently used medications (including anticoagulants and antiplatelet drugs)
- Records of previous surgeries (related to the pelvis or urinary tract), and previous endoscopic procedures, dilations, or urethroplasties
- Results of previous imaging studies, uroflowmetry, and urine cultures (printed copies or a CD if possible)
- Records of urinary symptoms (a voiding diary, sensation of residual urine, whether acute obstruction has occurred), and urination patterns (nocturia, urgency, etc.)
- Recent sexual history and sexually transmitted infection (STI) test results, if available
- Questions to record in advance for the outpatient visit (providing these directly to the healthcare provider during the visit may be helpful)
- When the symptoms began and how they have progressed (gradual progression vs. sudden worsening)
- Whether you have previously had catheterization or pelvic trauma
- Any recent history of urinary tract infection or fever
- Things to confirm before receiving care
- If you are taking anticoagulants, confirm whether they need to be discontinued before the procedure
- Report the management status of comorbidities such as diabetes and cardiovascular disease
4) Examples of General Questions to Ask the Doctor
- What treatment options are recommended for my stricture, and what are their advantages and disadvantages?
- What are the success rates (recurrence rates) of each treatment, and what is the expected recovery period?
- How might the treatment affect my sexual function (erection and ejaculation)?
- What additional tests will I need before and after the procedure or surgery?
- What lifestyle changes or preventive measures can help reduce recurrence?
5) Examples of Disease-Specific Questions
- Exactly where is my stricture located, and how long is it (based on the retrograde urethrogram and endoscopy results)? What treatment method do you recommend accordingly?
- Between endoscopic incision (DVIU) and urethroplasty (for example, buccal mucosa graft or EPA), which option is more suitable for me? If it recurs, what treatment would you recommend as the next step?
Note: Symptoms and treatment choices vary depending on the location, length, and cause of the stricture and the patient's overall health. An accurate evaluation and treatment plan should be determined based on an examination by a urology specialist, imaging studies, and endoscopic findings.