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Treatment

Foley Catheter
Foley Catheter
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How a benign lesion is treated depends on the type and where it is. Abscesses, urethral injuries, and infections need to be treated quickly. Your urologist has many meds and methods to deal with these lesions.

Abscesses linked to gonococcal urethritis can be treated well with antibiotics. Your urologist may also need to surgically drain the abscess. You may need a catheter in the bladder (Foley catheter) or a tube in the bladder through the belly (suprapubic tube) to keep urine out of the urethra until it heals. After the urethra heals, you should be able to pee as usual.

Urethral Stricture Disease

To treat urethral stricture disease, your urologist needs to know where the scars are. This is done with an x-ray test called urethrography. A special dye is infused into the urethra through the tip of the penis. When an x-ray is taken, the dye will show where and how long the scars are. If these strictures are very dense or if they block the channel, a more detailed voiding study through a small cut above the pubic bone may be needed.

Suprapubic catheter
Suprapubic catheter
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Urethral strictures are often treated by making the channel wider. This is done either through stretching (dilation) or surgery.

Dilation

Dilation is a way to stretch the narrow urethra back to its normal width. A tube slightly wider than the urethra is passed through its outlet into the bladder. The tube is taken out and slightly larger tubes are used until the opening is stretched to the right width. The procedure is done using anesthetic jelly on the skin. Your urologist may use a urethroscope to look into the urethra. Dilation may cause some discomfort, which may be worse with tighter, denser strictures. Your urologist may place a urethral catheter into the urethra for 24 hours or longer afterwards to drain the bladder. Dilation is often only useful for very short strictures. If you've had stricture dilation before, another isn't likely to permanently fix the problem. But the time it takes for a stricture to form again varies, so this treatment may still be useful for some patients.

Surgery

Urethrotomy. Direct vision internal urethrotomy (DVIU) may work well for short strictures (less than about ¾ inch). Using a cystoscope, the urologist feeds a small knife through a tube into the urethra and makes a deep cut through the stricture. Making a single cut through the scarred stricture exposes the healthy epithelial tissue below. This should allow the urethra to re-cover itself with more normal tissue. DVIU is most often done with the patient under general anesthesia. This procedure may need to be done again  if the stricture reforms.

Urethroplasty. Long strictures and scars in the urethra close to the penis outlet don't react as well to DVIU or dilation. Those scars--and completely destroyed urethras--can be dealt with by surgery to rebuild the urethra (urethroplasty), but results vary. Urethroplasty is done by making a cut in the penis or the perineum and taking out the scar tissue. The healthy tissues at the ends of the urethra are rejoined.

Sometimes a skin graft is sewn in to replace the urethra at the stricture. This skin is taken from inside the cheek or some other part of the body. A catheter is often needed for several weeks after this procedure.

Other Methods

Permanent metal stents have been implanted for bulbar urethral strictures, but aren't useful for most patients. Non-cancerous urethral growths can be hard to treat. Lasers can be used to destroy the lesions seen with genital warts (from HPV). Some health care providers suggest using skin creams. As of now, no technique reliably cures this health issue or keeps the virus from coming back.

Lichen Sclerosis (LS) or Balanitis Xerotica Obliterans (BXO)

LS and BXO are treated with agents that kill bacteria and reduce swelling. Circumcision may be needed. If scars block the urethra, more reconstructive surgery may be needed.

Urethral Polyps

Urethral polyps can be removed using cystourethroscopy. Your urologist can peer into the urethra with a small, flexible camera and use miniaturized tools to remove the growth.

Paraurethral Cyst

Paraurethral cysts don't need to be treated if there are no symptoms. Most often, these pop and shrink on their own. But if there's a block, infection, or if pain occurs, your urologist may pierce the cyst with a scalpel blade to drain it and ease the symptoms.

Urethral Caruncle

Urethral caruncle cysts don't need to be treated if there are no symptoms. Some urologists suggest using estrogen cream or HRT to make the caruncle go away. If the caruncle is large or causes problems, your urologist may remove it and burn its base.

Urethral Prolapse

Urethral prolapse is treated by surgically removing the prolapsed tissue. The membrane is then stitched in place to keep it from occurring again.