Urethral Stricture Treatment in Singapore

• Men experiencing slow or weak urine stream despite adequate bladder pressure
• Patients with recurrent urinary tract infections linked to incomplete bladder emptying
• Individuals requiring frequent catheterisation due to urinary retention
• Those experiencing spraying or double stream during urination
• Patients with confirmed urethral stricture on diagnostic imaging
• Men who have failed conservative management approaches
• Individuals healthy enough to undergo the recommended procedure
• Patients committed to following post-treatment care instructions

• Active urinary tract infection requiring treatment before procedure
• Severe bleeding disorders that increase surgical risks
• Certain medications that affect healing or blood clotting
• Uncontrolled medical conditions that make anaesthesia unsafe
• Extensive urethral damage requiring staged reconstruction
• Previous pelvic radiation affecting tissue quality

A thorough evaluation by an MOH-accredited urologist is essential to determine the most appropriate treatment approach. This assessment includes reviewing your medical history, conducting physical examinations, and performing diagnostic tests to map the stricture’s characteristics.

Urethral dilation is a minimally invasive procedure where graduated dilators or balloons gently stretch the narrowed area. This office-based procedure provides temporary relief and is suitable for short, simple strictures. The procedure takes 15-30 minutes and allows immediate return to normal activities, though the stricture often recurs, requiring repeat treatments.

DVIU involves using a specialised scope with a blade or laser to cut through the scar tissue under direct visualisation. This endoscopic procedure is performed under anaesthesia and is effective for short strictures (less than 2cm) in the bulbar urethra. The procedure typically takes 30-45 minutes, with most patients going home the same day.

Urethroplasty represents the gold standard for definitive stricture treatment, offering good long-term success rates. This surgical reconstruction involves either removing the narrowed segment and reconnecting the healthy ends (excision and primary anastomosis) or using tissue grafts to widen the urethra (substitution urethroplasty). The procedure choice depends on stricture location and length.

Modern urological facilities employ flexible cystoscopes for visualisation, specialised urethrotomes for precise incisions, and various graft harvesting instruments for reconstructive procedures. Laser technology may be used for certain stricture types, offering precise tissue removal with minimal bleeding. Imaging guidance ensures accurate treatment delivery.

Before your procedure, you’ll undergo urine tests to rule out infection and imaging studies such as retrograde urethrography or voiding cystourethrography to map the stricture. Blood tests assess your overall health and clotting function. You’ll receive specific instructions about medications to stop, typically including blood thinners 5-7 days before surgery. Fasting requirements depend on the procedure type and anaesthesia planned.

For outpatient procedures, arrange transport home as you cannot drive after sedation. For urethroplasty requiring hospitalisation, prepare your home for recovery by ensuring easy bathroom access and gathering prescribed supplies.

For dilation or DVIU, you’ll receive local anaesthesia with sedation or spinal anaesthesia. The urologist inserts a cystoscope to visualise the stricture, then performs the chosen intervention. These procedures typically last 30-60 minutes.

Urethroplasty requires general or spinal anaesthesia. The surgeon makes an incision in the perineum or penis, depending on stricture location. For short strictures, the scarred segment is removed and healthy ends joined. Longer strictures require graft tissue, often harvested from the inner cheek (buccal mucosa) or penile skin. The procedure takes 2-4 hours depending on complexity.

After minimally invasive procedures, you’ll recover for 1-2 hours before discharge. A temporary catheter may be placed to ensure proper drainage while initial healing occurs. You’ll receive pain medication and antibiotics to prevent infection.

Following urethroplasty, you’ll stay in hospital for 1-2 days. The surgical site is monitored for bleeding or complications. A catheter remains in place for 2-3 weeks to allow the reconstruction to heal properly. Pain management includes oral medications and ice packs to reduce swelling.

Expect mild discomfort and possible blood in the urine, which is normal. For minimally invasive procedures, resume light activities but avoid strenuous exercise. Keep the catheter secured and maintain good hygiene around the insertion site. Watch for signs of infection including fever, severe pain, or purulent discharge.

After urethroplasty, limit movement to prevent stress on the surgical site. Sit on a donut cushion to reduce perineal pressure. Take prescribed antibiotics as directed and use stool softeners to avoid straining. Ice packs applied for 20 minutes at a time help manage swelling.

Continue catheter care as instructed, keeping the drainage bag below bladder level. Gradually increase activity levels but avoid heavy lifting, cycling, or activities that put pressure on the perineum. Maintain good hydration to flush the urinary system. Attend your follow-up appointment for wound check and catheter management review.

For urethroplasty patients, the surgical site may develop bruising that extends to the scrotum or thighs – this is normal and resolves over 2-3 weeks. Continue prescribed medications and report any concerning symptoms to your urologist immediately.

Catheter removal timing varies by procedure – typically 3-7 days for DVIU and 14-21 days for urethroplasty. A voiding trial confirms adequate urine flow before removal. Initial urination may cause mild burning or urgency, which improves over several days.

Regular follow-up includes flow rate tests and periodic cystoscopy to monitor healing and detect early recurrence. Most patients return to normal activities within 4-6 weeks after urethroplasty. Sexual activity can typically resume 6 weeks post-surgery after surgical clearance.

Temporary blood in urine occurs in most patients and resolves within days. Mild pain or discomfort at the treatment site responds well to prescribed medications. Urinary urgency and frequency are common initially as the bladder adjusts to improved flow. Some patients experience temporary difficulty controlling urine stream direction.

Catheter-related discomfort includes bladder spasms and irritation at the insertion site. These symptoms are manageable with medications and resolve after catheter removal.

Infection risk exists with any urological procedure but is minimised through sterile technique and prophylactic antibiotics. Stricture recurrence rates vary by treatment type – higher with dilation (50-80%) and DVIU (30-50%), lower with urethroplasty (10-20%).

Rare complications of urethroplasty include urinary incontinence, erectile dysfunction, or urethrocutaneous fistula formation. Graft failure may require revision surgery. Choosing an experienced urologist who performs these procedures regularly significantly reduces complication risks through refined technique and patient selection.