What is a urethral stricture?
A urethral stricture is a narrowing of the urethra — the tube that carries urine from the bladder out of the body. This narrowing is caused by scar tissue, which can develop following infection, inflammation, injury, prior instrumentation, or as a long-term effect of cancer treatment such as radiation.
The two most critical factors in planning treatment are location and length. Strictures can occur anywhere along the urethra — from just below the bladder to the tip of the penis — and can range from a few millimeters to the entire length of the urethra. A short stricture in one location may be straightforward to repair, while a long or pan-urethral stricture requires a fundamentally different surgical approach. Prior treatments matter equally: a urethra that has already undergone dilation, urethrotomy, or prior urethroplasty has altered tissue that directly affects what options remain.
Left untreated, strictures can worsen over time and lead to bladder or kidney complications. Choosing the right treatment the first time — and understanding how prior treatments narrow future options — is one of the most important aspects of Dr. Wiegand's evaluation.
Who gets urethral strictures?
Urethral strictures occur almost exclusively in men. Common causes include prior urethral instrumentation (catheters, cystoscopy), hypospadias repair, pelvic trauma, lichen sclerosus (a skin condition), prior infections, and radiation therapy for prostate or bladder cancer. Many patients arrive having already had one or more prior treatments — this history is essential to the evaluation and shapes what approaches are still available.
How do you know if you have one?
Symptoms of urethral stricture relate to difficulty with urination and can range from mild to severe. Common symptoms include:
Some patients have had a slow stream for so long they consider it normal. If you've noticed any change in your urinary stream, it's worth an evaluation.
A focused, minimally invasive diagnostic approach
Dr. Wiegand intentionally limits the number of invasive studies used in the evaluation of urethral stricture — a deliberate departure from the approach taken by many reconstructive urologists. Unnecessary imaging adds cost, discomfort, and anxiety without changing the treatment plan in most cases.
Why fewer tests is often better
Many patients arrive having already undergone multiple invasive studies at other institutions. Dr. Wiegand's philosophy is to use the minimum necessary workup to make a confident, well-informed treatment decision — and to avoid repeating studies that have already been done and remain valid.
-
History & Symptom Assessment
A thorough history of symptoms, prior procedures, infections, trauma, and cancer treatment is the foundation of every evaluation. In many cases this alone — combined with flow studies — guides the treatment decision.
-
Uroflowmetry & Post-Void Residual
Simple, non-invasive tests measuring urine flow rate and how much urine remains in the bladder after voiding. These are the most patient-friendly tools for confirming obstruction and monitoring treatment success.
-
Cystoscopy / Urethroscopy
When direct visualization is needed, a small flexible camera is used to assess the stricture. This is often sufficient on its own to plan treatment, without requiring contrast imaging studies.
-
Retrograde Urethrogram (RUG) & VCUG — Used Selectively
Contrast X-ray studies to outline the urethra are used only when the information they provide would meaningfully change the treatment approach. Dr. Wiegand does not order these routinely — they are reserved for cases where anatomy is genuinely unclear from other studies.
-
Urethral MRI & Ultrasound — Rarely Needed
Advanced soft tissue imaging such as MRI urethrography or ultrasound assessment of spongiofibrosis is available but used only in exceptional circumstances. The vast majority of patients do not require these studies, and Dr. Wiegand will not order them unless they would directly inform a complex surgical decision.
Conservative & minimally invasive approaches
Not every stricture requires open surgery. Dr. Wiegand will discuss all options honestly, including their long-term success rates, so you can make an informed decision.
Urethral Dilation
Gradual stretching of the stricture using progressively larger dilators. Provides temporary relief but does not address the underlying scar tissue. Recurrence rates are high, often within months. May be appropriate as a temporizing measure or for patients who are not surgical candidates.
Direct Vision Internal Urethrotomy (DVIU)
An endoscopic procedure in which the stricture is incised with a small blade or laser under direct vision. Best suited for short, simple strictures in specific locations. Success rates decrease significantly with repeat procedures or longer strictures. Dr. Wiegand will discuss whether DVIU is appropriate for your anatomy.
Optilume® Drug-Coated Balloon (DCB)
Optilume is an FDA-approved drug-coated balloon system for men with recurrent anterior urethral strictures up to 3 cm in length. It combines mechanical balloon dilation with local delivery of paclitaxel — an anti-scarring medication — directly to the stricture site during a single endoscopic procedure.
Unlike standard dilation or DVIU, the paclitaxel coating works to inhibit scar tissue regrowth after dilation, offering more durable results than traditional endoscopic options. At 2 years, roughly three-quarters of patients in the landmark ROBUST III trial remained free from repeat intervention — significantly better than standard endoscopic management alone. Five-year data show 72% freedom from repeat intervention with sustained improvements in urine flow and symptom scores.
Optilume is performed cystoscopically as an outpatient procedure. A Foley catheter is left in place for 2–5 days afterward. Men should use a condom or abstain from sex for 30 days following treatment due to paclitaxel present in semen.
Dr. Wiegand has contributed to published research evaluating Optilume in patients with prior urethroplasty — a population excluded from the original ROBUST trials — and is experienced in offering this option to appropriately selected patients.
Intermittent Self-Dilation (ISD)
In rare circumstances where a patient is unable to undergo further reconstruction — due to medical comorbidities, personal preference, or prior exhaustion of surgical options — intermittent self-dilation may be used as a long-term management strategy. The patient periodically passes a small catheter to keep the urethra open.
Dr. Wiegand considers ISD a last resort and will always explore every reconstructive option first. The goal for every patient is a durable surgical solution that eliminates the need for ongoing self-management.
Definitive reconstruction: Urethroplasty
Urethroplasty is the gold-standard surgical treatment for urethral stricture and offers the highest long-term success rates of any available treatment. Dr. Wiegand has extensive experience in all urethroplasty techniques.
Anastomotic Urethroplasty
The scarred segment of urethra is excised and the healthy ends are reconnected directly. Best suited for short strictures (typically less than 2 cm) in the bulbar urethra. Success rates exceed 90% at 5 years. This is often the most durable repair available.
Substitution Urethroplasty (Buccal Mucosa Graft)
For longer strictures where excision and reanastomosis isn't possible, the urethra is widened using a graft of tissue — most commonly buccal mucosa (inner cheek lining). The graft is used to patch or replace the scarred segment. Success rates of 80–90% at 5 years for appropriately selected patients.
Transurethral & Advanced Techniques
For complex or longer strictures — including those involving the penile urethra, prior failed repairs, or significant scar tissue — newer transurethral and advanced open techniques allow definitive single-stage repair that was previously not possible. These approaches avoid the need for multiple surgeries and significantly reduce patient anxiety and recovery burden.
Dr. Wiegand incorporates techniques from leading reconstructive urologists including those pioneered by Nikolavsky, Warner, and Kulkarni, offering patients single-stage options for even the most complex urethral anatomy.
What to expect after your procedure
Detailed instructions for each procedure are provided below. Please follow these carefully and call our office if you have any concerns.
After Optilume Urethral Dilation
Dr. Lucas Wiegand · Orlando Health
What to Expect
- • You will go home the same day
- • A small catheter is left in place overnight — remove it yourself the next morning per instructions
- • Blood in urine (hematuria) is common and may persist intermittently for several weeks to months
- • Burning, urgency, or frequency is normal and should improve gradually
Activity & Sexual Activity
- • Resume normal physical activity the day after catheter removal
- • No restrictions on exercise or lifting unless advised
- • Resume sexual activity after 2 days
- • Condom use required for 30 days after the procedure
- • Avoid pregnancy for 6 months — paclitaxel coating may pose reproductive risks
Medications
- • No prescriptions or narcotics needed
- • AZO (phenazopyridine) OTC for burning — limit to 2 days
- • Ibuprofen or acetaminophen for mild discomfort
- • Drink plenty of fluids to flush the urinary tract
Call Our Office If You Have
- • Fever >101°F or chills
- • Inability to urinate after catheter removal
- • Large blood clots or persistent bleeding
- • Severe pain not relieved by OTC medications
- • Foul-smelling urine or signs of infection
Follow-up appointment scheduled at 4–6 weeks to assess recovery and urinary flow.
After Urethroplasty with Buccal Mucosal Graft
Dr. Lucas Wiegand · Orlando Health · (877) 876-3627
Catheter Care
- • You go home with a urethral catheter (Foley) in place for 3–4 weeks
- • Some patients also have a suprapubic tube (SPT) draining to a bag
- • The urethral catheter should be capped (not draining) unless directed
- • Some leakage around the catheter is normal
- • Do not remove or flush catheters unless instructed
- • Keep tubing and insertion site clean and dry
Medications
- • Percocet (Oxycodone/Acetaminophen) — pain control
- • Ditropan (Oxybutynin) — reduce bladder spasms
- • Pyridium (Phenazopyridine) — relieve urinary burning
- • Magic Mouthwash — oral soreness from cheek graft
- • Take all medications exactly as prescribed
Buccal Graft Site (Inside Cheek)
- • Some soreness, swelling, or bleeding is normal
- • Use magic mouthwash as prescribed
- • Avoid citrus or spicy foods for the first week
- • Gentle rinsing with salt water recommended
- • Maintain excellent oral hygiene
Call Our Office If You Have
- • Fever >101°F (38.3°C) or chills
- • Nausea, vomiting, or inability to eat/drink
- • Significant bleeding from catheter, cheek, or urethra
- • Signs of infection at catheter site (redness, pus, swelling)
- • Catheter stops draining or falls out
Activity: No specific restrictions after surgery. Avoid bicycle riding until cleared. The catheter and incision may naturally limit activity.
Ready to discuss your options?
Dr. Wiegand offers consultations for new stricture patients and second opinions for those already scheduled for treatment elsewhere.
Request a Consultation