Dr. Sean Elliott, MD
Reconstructive Urologist
Urethral Dilation and Optilume
Urethral dilation success rates are not as good as success rates with urethroplasty. But, if dilation is going to work, it works best in short strictures, especially those in the portion of the urethra shown here, that part right behind the scrotum that we call the bulbar urethra. Success rates here can be 50-70% at one year for strictures being treated for the first time, compared to about 90% for urethroplasty.
prostate
urethra
urethral stricture
front
bladder
rectum
back
Urethral dilations involves threading a narrow deflated balloon on the end of a skinny long tube across the stricture. The balloon is then inflated.
prostate
front
bladder
rectum
back
The inflated balloon cracks the scar tissue. Scar tissue is not stretchable; so, the dilation causes several fissures (or splits) in the scar. In these cracks is, hopefully, some healthy tissue. When that tissue heals in the cracks, the hope is that it will re-line with urethra tissue rather than scar tissue. That is what turns a temporary success into a long-term success.
Urethral stricture (green)
Dilation creates cracks in the stricture, exposing underlying healthy tissue (pink)
If healthy urethra grows in the exposed areas then we have a long-term success
If scar tissue grows in these cracks then the success will only last a few weeks
prostate
urethra
bladder
rectum
Optilume
Optilume is a new device for the treatment of urethral stricture. Dr. Elliott was the lead physician investigator of the clinical trial that led to FDA approval of this device. Optilume combines dilation of the stricture with circumferential delivery of a drug (paclitaxel, shown as white snowflakes in the figure) that fights scar tissue formation. When paclitaxel dissolves into the cracks in the scar tissue and into the underlying healthy tissue, it helps prevent scar from forming in that healthy tissue exposed in the cracks. In the clinical trial, success rates with Optilume were nearly three times better than than with a standard balloon.
bladder
front
urethra
prostate
urethral stricture
back
rectum
Dilation is performed just like a regular dilation. But in the Optilume case, the paclitaxel drug is implanted into the fissures/cracks in the scar tissue.
In the right patients, the urethra heals widely open about 70% of the time.
In the right patients, the stricture recurs about 30% of the time.
