Improve Urinary Flow & Comfort
A urethral stricture is scar tissue that narrows the urethra, the channel that carries urine from the bladder out of the body. It can cause a weak stream, straining, spraying, incomplete bladder emptying, urinary infections, or even an inability to urinate. Because strictures differ greatly in location, length, cause, and previous treatment, the best treatment is not the same for every patient.
At East Coast Advanced Urology in Clifton, NJ, Dr. Karl Coutinho specializes in urethral stricture disease and complex urethral reconstruction. His practice includes the full spectrum of evaluation and treatment, from endoscopic procedures and drug-coated balloon therapy to open urethroplasty.
A stricture forms when scar tissue narrows part of the urethra and restricts urine flow. It may develop after trauma, infection or inflammation, catheterization or instrumentation, prior urologic surgery, radiation, prostate treatment, or previous reconstruction. In some patients, no single cause can be identified.
Common symptoms include:
Evaluation begins with symptoms and previous procedures, injuries, radiation, and prior stricture treatments. Testing may include urine-flow measurement, measurement of urine left in the bladder after urination, cystoscopy with a small camera, and a retrograde urethrogram in which contrast outlines the urethra on X-ray. Accurately defining the location and length of the stricture is particularly important when reconstruction is being considered.
Treatment depends on location, length, whether the stricture is new or recurrent, surrounding scar tissue, previous procedures, overall health, and patient priorities.
Dilation stretches the narrowed segment, while internal urethrotomy opens the scar from inside the urethra. These procedures can be reasonable for selected short strictures, particularly as initial treatment, but recurrence is common after repeated endoscopic treatment.
For appropriately selected recurrent bulbar urethral strictures shorter than 3 centimeters, dilation or internal urethrotomy can be combined with a drug-coated balloon such as Optilume. The balloon opens the narrowing while delivering paclitaxel to the treated tissue to reduce recurrent scar formation.
Urethroplasty is open reconstructive surgery used to repair the narrowed urethra. Reconstruction may involve removing a short scarred segment and reconnecting the healthy urethra or using tissue grafts, commonly tissue from the inside of the cheek, to widen or rebuild the channel.
Current guidance from the American Urological Association generally favors urethroplasty over repeated endoscopic treatment for recurrent anterior strictures after prior dilation or internal urethrotomy has failed, when durable reconstruction is appropriate. Reconstruction may also be preferred for penile, longer, and more complex strictures.
For selected patients with very complex disease, multiple failed reconstructions, or a high risk of another reconstructive failure, a perineal urethrostomy can create a new urinary opening in the perineum and serve as a durable long-term treatment.
A recurrent stricture does not necessarily mean that the same procedure should simply be repeated. The recurrence pattern, location, length, prior procedures, tissue quality, and patient goals should be reassessed. For many recurrent strictures, urethroplasty provides a more durable strategy.
Your Guide to Post-Urethral Stricture Treatment Care
Recovery depends on treatment. Endoscopic procedures generally have a shorter recovery and catheter period than open reconstruction. Urethroplasty usually requires a urinary catheter while the reconstructed urethra heals.
Follow-up may include symptoms, urine flow, bladder emptying, cystoscopy, or imaging because recurrence is possible after any treatment.
The cost of urethral stricture treatment in Clifton, NJ, and the greater New York metropolitan area depends on the evaluation and treatment required. Cystoscopy, urethral imaging, endoscopic treatment, drug-coated balloon therapy, and urethroplasty have different facility and insurance requirements. The office can help review your benefits.
Dr. Karl Coutinho is a fellowship-trained reconstructive urologist whose practice has a particular focus on urethral stricture disease. After urology residency at Mount Sinai Hospital, he completed fellowship training in genitourinary trauma and reconstruction at Northwestern Memorial Hospital and University Hospitals of Cleveland.
His academic work is directly related to urethral stricture treatment. Dr. Coutinho served as Co-Primary Investigator for the randomized ROBUST III clinical trial of the Optilume drug-coated balloon, co-authored the published one-year and two-year results, co-authored a technical article describing how the procedure is performed, and presented four-year ROBUST III results in 2025. Because his practice includes both minimally invasive treatment and open reconstruction, he can discuss the advantages and limitations of each approach within the same consultation.
East Coast Advanced Urology
If you have a weak urinary stream, recurrent urethral narrowing, difficulty emptying your bladder, or a stricture that has returned after previous treatment, schedule a consultation with Dr. Karl Coutinho at East Coast Advanced Urology in Clifton, NJ. Dr. Coutinho welcomes patients from throughout the greater New York metropolitan area.
Contact the office to schedule your consultation.