Urethral dilation is a common urological procedure performed to gently widen a narrowed section of the urethra, which is the tube that carries urine from the bladder out of the body. The goal is to restore a normal channel size, allowing urine to flow freely. This minimally invasive treatment is typically managed by a urologist, often in an outpatient setting, using specialized instruments to physically stretch the constricted area. The procedure offers a temporary or long-term solution for patients experiencing difficulty with urination due to a physical narrowing of the urinary pathway.
Why Urethral Dilation is Necessary
The primary reason for performing urethral dilation is the presence of a urethral stricture, a segment of scar tissue (spongiofibrosis) that has narrowed the diameter of the urethra. This scar tissue can form due to various factors, including pelvic trauma, infection, or injury from previous surgical procedures or catheterization. The resulting constriction impedes the flow of urine.
Patients often seek treatment because they experience a slow or weak urine stream that may also spray or split, indicating a physical blockage. The obstruction makes it difficult to completely empty the bladder (incomplete voiding), which increases the frequency of urination. This inability to empty the bladder fully raises the risk of developing urinary tract infections, as residual urine provides a breeding ground for bacteria. Back pressure created by the stricture can also lead to long-term problems, such as bladder stones or damage to the kidneys.
The Procedure and Techniques Used
Preparation for urethral dilation often begins with anesthesia, ranging from a local anesthetic gel applied directly into the urethra to moderate sedation or general anesthesia. Once prepared, the urologist uses specialized instruments to progressively stretch the narrowed segment. The choice of technique depends on the length and severity of the scar tissue.
Traditional Dilation Methods
One traditional method involves sequential dilators, which are long, thin rods known as sounds. These instruments are lubricated and inserted one after the other, with each subsequent sound having a slightly larger diameter to gradually expand the stricture. Another approach utilizes filiforms and followers. A very narrow, flexible filiform is first guided through the stricture and then attached to progressively larger “followers” to achieve the dilation.
Balloon Dilation
An alternative technique is balloon dilation, which employs a specialized catheter with a small balloon at its tip. The catheter is advanced across the stricture, often over a guidewire. The balloon is then slowly inflated with fluid to a specific pressure, applying radial force to widen the urethra. Newer variations allow for dilation under direct visualization using a cystoscope, which provides the urologist with a view of the stricture as it is being stretched, potentially reducing the risk of complications like perforation.
Recovery and Post-Procedure Expectations
Following the procedure, patients are typically monitored for a short period and can often return home the same day. It is common to experience temporary side effects for one to two days, including mild bleeding in the urine, a burning sensation or discomfort while urinating, and an increased urge to pass urine.
A temporary urinary catheter may be left in place for a few days to ensure the urethra remains open and facilitate initial healing, though this is not always necessary. Drinking extra fluids, particularly water, is recommended to manage discomfort and flush the urinary system. Most individuals can resume normal daily activities, including walking, within 24 to 48 hours, though strenuous activity should be avoided briefly.
Risks and Addressing Stricture Recurrence
While urethral dilation is considered a minimally invasive treatment, it carries potential risks, including infection and excessive bleeding. Less common but more severe risks involve creating a false passage or perforation in the wall of the urethra. These complications are usually minimized through careful surgical technique and patient selection.
The most significant limitation of urethral dilation is the high probability of the stricture returning, or recurring, over time. Because the procedure stretches rather than removes the underlying scar tissue, the body’s natural healing response can cause the tissue to narrow again. For many patients, the temporary benefit of a single dilation disappears within six months. If strictures recur frequently, the urologist may teach the patient to perform self-dilation at home using a catheter to maintain the opening. If dilation is no longer effective, a more extensive surgical repair, such as urethroplasty, which removes or reconstructs the scarred segment, may be necessary.