The very latest frontiers in the treatment of urethral stricture
Italy confirms itself as a world leader in urethral surgery, a specialization in which Made in Italy is synonymous with excellence thanks to the work of Prof. Salvatore Sansalone and Prof. Guido Barbagli who gave his name to a reconstructive technique used in the treatment of urethral stricture. A pathology of the male genital system that consists in the narrowing or even complete obstruction of the lumen of the urethra, the channel through which the urine accumulated in the bladder is expelled. “An operation not performed in a workmanlike manner can lead to complications, damage to sexual function and the need to intervene again, as well as a series of psychological problems that can interfere with sexual and couple life. This is the reason why you should only turn to highly specialized centers! ” emphatically asserts Dr. Salvatore Sansalone, first-rate Urologist Andrologist, Director of the Urethral Reconstructive Surgery Center, Adjunct Professor of the Tor Vergata University of Rome, Urologist Consultant at the Ministry of Health, formerly head of the Center for Male Infertility of the structure itself.
by Roberta Imbimbo
Prof. Sansalone, what can be the causes of this highly disabling pathology?
The stenosis of the urethra is determined by the formation of scar tissue such as to cause partial or total obstruction; this formation may depend on various factors: urinary or sexual infections, trauma related, for example, to the use of urinary catheters or traffic accidents, diseases such as Lichen Sclerosus, tumors or unsuccessful hypospadias surgery. In all these cases it is necessary to reopen the urethral canal and restore its functionality, all while preserving the sexual and aesthetic function.
In the presence of which symptoms it is advisable to consult a specialist?
Obviously the symptoms of urethral stenosis depend on the degree of stenosis itself: the most severe cases are characterized by gradually more severe disorders. Generally the patient complains: sensation of obstacle to the passage of urine, dripping shortly after urinating (post-voiding), incontinence, incomplete emptying of the bladder as well as the need to urinate often, burning when urinating, constant urinary infections sometimes even with fevers shaking, blood in urine and seminal fluid. When the symptoms described are accompanied by pain and / or affect the standard of living (as in the case of acute urinary retention or renal failure), it is advisable to consult a specialist. In this type of surgery, in fact, it is necessary to rely on qualified centers, whose surgeons have numerous cases to their credit each year, successfully treated thanks to the experience of the operators themselves. Not surprisingly, the Sanatrix Clinic wanted to fill the lack of highly specialized structures in Central-Southern Italy, opening the Center for Urethral Reconstructive Surgery, which I directed, which in a short time became an important national and international point of reference for the diagnosis and treatment of urethral stricture: professionals with well over 3000 operations performed to date, with an average of 400 cases a year, 25% of which from all over the world!
How is this pathology treated today?
To resolve urethral stricture, surgery must be performed. The choice of surgery obviously depends on the characteristics of the pathology (cause, length and site) and the patient’s medical history (age, related diseases, general conditions, etc.).
Endoscopic urethrotomy is an absolutely minimally invasive technique, which consists of an endoscopic incision of the urethral canal using a “cold” blade (urethrotomy according to Sachse). The success of the method is around 60%: its main limitation is, in fact, represented by the fact that it can only be proposed in the case of short urethral strictures. The only valid long-term solution is represented by urethroplasty, a delicate specialized procedure that involves the removal and / or replacement of the stenotic urethral segment with an oral mucosal transplant. In expert hands, the success rate of this surgical technique is very encouraging (85%). In the case of a post-traumatic urethral stenosis of about 1 / 1.5 cm in length, the end to end anastomosis technique can be used, which guarantees a success of 92%.
Prof. Sansalone, Prof. Barbagli gave his name to a reconstructive technique used in the treatment of urethral stricture. What is it about?
It is a real intervention, which combines urology with reconstructive plastic surgery and andrology, thanks to which it is possible to restore