Prof. Salvatore Sansalone, Urologist/Andrologist, specialist in urethral and genital reconstructive surgery. Professor at the University of Tor Vergata, Consultant of the Ministry of Health and Co-founder of UroClinic, a highly specialised Urological Centre able to offer patients the latest generation diagnostic tools and therapies, in this long interview he talks about the latest frontiers in the treatment of urethral stenosis.
by Roberta Imbimbo

Prof. Sansalone, what is urethral stenosis?
Urethral stenosis, a highly invalidating pathology that mainly affects males over 50, refers to the reduction or complete obstruction of the lumen of the urethra, i.e. the channel from which urine escapes, due to multiple factors that lead to a growth of scar tissue at the level of its spongy wall. There are many causes of urethral stenosis, such as urinary infections, urethral trauma, instrumental manoeuvres in the urethra (catheterisation, urethroscopy, cystoscopy, urological interventions) Lichen Sclerosus disease, failed hypospadias, urethral cancer. By means of an accurate anamnesis and specific instrumental examinations, such as uroflowmetry, retrograde urethrocystography, urinalysis and urethroscopy, the specialist is able to precisely determine the cause of the stenosis, identifying the urethral tract involved (anterior or posterior), the degree of severity of the pathology, the impact on the patient’s quality of life, and the most effective therapeutic approach, which depends on the aetiology, length and site of the stenosis. Most of the time, the therapeutic choice falls on surgery. Today, however, enormous progress has been made in this field: there is in fact a minimally invasive treatment, called Optilume, which guarantees very positive results in opening up the stricture and preventing the formation of further scar tissue that usually appears after traditional surgery.

More specifically, what does this innovative endoscopic treatment consist of?
It is a highly innovative minimally invasive device: during the procedure, a balloon is inserted into the urethral tract and then inflated to widen the fibrotic and narrowed area, mechanically dilating the stenosis; at the same time, this paolloncino releases Paclitaxel locally, a chemotherapeutic agent with anti-proliferative properties, with the aim of preventing the fibrotic tissue’s response, which over time could lead to a recurrence of the narrowing. In contrast to standard endoscopic urethrotomy, where the rate of recurrence and thus the need for reoperation is high, this new minimally invasive technique guarantees much higher success rates. Three years after treatment with Optilume, the percentage of patients who remain free of stenosis recurrence stands at 77%. This success rate confirms the durability of the results obtained with this method, which is particularly indicated in the case of small (less than 3 cm) or easily treatable stenoses, such as in young patients who have not already undergone major prostate surgery.

Is this a patient-friendly procedure?
Absolutely! It is an operation that can be performed on an outpatient basis (the patient comes out after a few hours and can safely resume his or her daily activities) without a catheter, with considerable benefits, including psychological ones. Since this is a very delicate operation, the success of which depends on the experience and skill of the operators, it is advisable to rely on highly specialised centres whose surgeons have several cases per year. Thanks to a highly qualified team and state-of-the-art equipment, UroClinic, and especially Prof Sansalone, an international expert in urethral and genital reconstructive surgery, is considered an excellence in this field, able to offer the highest level of care.

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