Surgery can repair urethral stricture: One woman’s story

Even knowing how painful it was to have her urethra dilated when it was obstructed and prevented her bladder from emptying, Patricia Moro was still hesitant to pursue a surgical repair.

Moro’s life began revolving around the bathroom. She could not travel because she had to stop so frequently for bathroom breaks. She did not sleep well because she was up 10 times a night. Even dining out became difficult, as did babysitting her grandchildren. When she needed to void and couldn’t, she would end up at a hospital emergency department for a painful catheterization.

Dimitriy Nikolavsky, MD

Dimitriy Nikolavsky, MD

She underwent repeated dilations to treat her stricture, an abnormal narrowing of the tube that leads out of the body from the bladder. It’s an obstruction caused by scar tissue from surgery, inflammation, disease or injury. Each time she was catheterized, weeks later, Moro would suffer urinary retention again. Finally Moro’s doctor referred her to Dmitriy Nikolavsky, MD,  Upstate University Hospital’s director of reconstructive urology and female urology and neurourology.

Having never undergone surgery, she was nervous.

“It was very hard for me to consider surgery,” says Moro, 48, of Cicero. “I listened to Dr. Nikolavsky. He made me feel secure.”

The surgeon says the use of dilation to treat strictures dates back 3,000 years to India, where practitioners worked with candles and the horns of animals to complete the task of widening the urethra. Then, as now, the procedure was not effective long-term.

Another treatment called an internal urethrotomy originated with the barber surgeons of medieval Europe. It used a dilation device with a pop-up knife but it, too, does not last.

Both dilation and urethrotomy procedures are still in use today, but Nikolavsky says urologists are beginning to favor urethroplasty, which is more invasive but has a success rate of 85 to 95 percent.

He developed an early interest in male and female reconstructive urology during residencies in surgery and urology at William Beaumont Hospital in Michigan. During that time, he traveled to Mozambique to perform female fistula repairs, and to India where he learned from one of the world leaders in genitourinary reconstruction. Nikolavsky then honed his urethroplasty skills during a reconstructive urology fellowship at the University of Colorado School of Medicine. He joined Upstate in 2012.

In Moro’s case, the surgery involved Nikolavsky cutting open the urethra, removing the scar tissue and covering the area with a graft of tissue taken from the inside of her cheek.

The surgery was first described in a medical journal more than a century ago, Nikolavsky says. It wasn’t appreciated at first, but for the last several decades urologists have realized that the buccal mucosa — as they refer to the inner cheek –makes for a perfect urethral graft. The tissue is moist, it doesn’t grow hair, and the inner cheek heals quickly. To the patient, it’s like a burn from biting into a too-hot slice of pizza.

Moro awoke from the operation with a large ice pack on the side of her face and a catheter, which she wore while her body recovered. Moro remembers that when the catheter was removed and she was able to void normally, Nikolavsky and his staff cheered.

“I have my life back,” she thought as she went home from his office that day.

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