Urethroplasty vs urethrotomy vs Optilume

Written by Mr Maj Shabbir FRCS(Urol), Consultant Urological Surgeon & Andrologist · 22 October 2026

If you have a urethral stricture, you have probably been offered, or already had, a dilatation or an optical urethrotomy. You may also have read about Optilume, a drug-coated balloon, and heard urethroplasty described as “the big operation”. These treatments are not interchangeable, and which one is right depends mainly on where your stricture is, how long it is, what caused it and what has already been tried.

I perform all three, so I have no reason to steer you towards any one of them. The table gives the short version; the rest of this guide explains the reasoning.

Why does repeated dilatation or urethrotomy tend to fail?

Because neither removes the scar. Dilatation stretches it and urethrotomy cuts it, and as the urethra heals, the scar tends to contract and narrow the channel again.

Both are endoscopic procedures, done through a telescope with no external cut. They give immediate relief and a quick recovery, which is why they are so often used first. The problem is durability. BAUS puts the risk of recurrence after a first optical urethrotomy at 1 in 2 (50%), and notes that the risk of further recurrence is higher after a second or third dilatation or urethrotomy. Endoscopic procedures rarely result in a permanent cure.

The repeat procedure is not neutral either. Each one adds scar tissue and lengthens the stricture, so a stricture that could once have been repaired simply may, several stretches later, need a more complex reconstruction. That is the real cost of the cycle: not only the repeated procedures, but a harder operation at the end of it.

How do the length and location of a stricture decide the treatment?

They are the main factors, alongside the cause and previous treatment. Short bulbar strictures have the widest range of options; long and panurethral strictures generally need reconstruction.

This is why a stricture has to be mapped before anything is booked. Assessment includes a flow rate and bladder scan, a flexible cystoscopy, and a urethrogram — a contrast X-ray showing exactly where the narrowing is and how long it is. The factors I weigh are:

• Location. The bulbar urethra, beneath the scrotum, is the commonest site, and it is where Optilume is licensed for use. Penile strictures are repaired by penile urethroplasty in one or two stages, and panurethral disease, where the whole urethra is involved, by a longer reconstruction.
• Length. Optilume is licensed for recurrent bulbar strictures less than 3cm long, and excision with primary anastomosis — cutting out the scar and joining the healthy ends — suits short bulbar strictures. Very long strictures are not suitable for Optilume.
• Cause. Lichen sclerosus rules out Optilume, and it means genital skin cannot be used as graft material, because the disease affects that skin too.
• Previous treatment. More than one previous dilatation or urethrotomy points towards reconstruction rather than another endoscopic attempt.
• Fertility plans. Optilume delivers paclitaxel, so it is not the right choice if you are hoping to father a child soon.
• Your health and priorities. If open surgery carries higher risk because of other health problems, Optilume or regular self-catheterisation may be the better fit. If you want the most durable result, that is urethroplasty.

Is Optilume better than urethroplasty?

Not for durability: urethroplasty remains the most durable treatment for stricture disease. Optilume is a less invasive option for selected short, recurrent bulbar strictures.

Optilume works on two principles at once. The balloon dilates the narrowed segment, as a conventional dilatation would, and as it does so it delivers paclitaxel, an anti-proliferative drug, into the wall of the urethra to interrupt the scarring that makes ordinary dilatation fail.

Whether it is “better” depends on what you are optimising for. Optilume is usually a day case with a catheter for a few days, and most men are back to normal activities within a few days of the catheter coming out. Urethroplasty means an open operation, one or two nights in hospital and a catheter for two to three weeks, in return for the most durable result. BAUS describes urethroplasty as having a much higher success rate in curing symptoms and preventing the stricture from returning than most other forms of treatment.

There is also a difference in the depth of evidence. Longer-term data on drug-coated balloons in the urethra is still accumulating, compared with decades of evidence behind urethroplasty. Being offered the least invasive option is not the same as being offered the best one for your stricture.

How long will Optilume last?

Nobody can yet give a reliable long-term figure. Published trial data supports better durability than standard endoscopic treatment, but follow-up is shorter than for urethroplasty.

Optilume is not presented as a permanent cure. Its aim is to lengthen the interval before a stricture recurs, compared with conventional dilatation. After treatment, follow-up includes flow rate measurement at intervals, because a falling flow rate is the earliest sign of recurrence and often appears before symptoms return.

Who is a good candidate for Optilume?

Typically a man with a short bulbar stricture, generally under 3cm, that has come back after earlier endoscopic treatment, and who would rather avoid open surgery.

That matches how it is approved. BAUS describes Optilume as licensed for recurrent bulbar strictures less than 3cm long, and its NICE approval covers recurrent anterior urethral strictures only. It may also suit a man for whom open surgery carries higher risk because of other health problems. It is not appropriate for:

• a stricture that has never been treated before, since the licence and approval are for recurrent strictures
• very long strictures, or panurethral disease
• strictures caused by lichen sclerosus
• men who are trying to father a child, or plan to soon

On that last point, paclitaxel is a medicine also used in cancer treatment. NHS hospital patient information advises abstaining from sex or using barrier contraception such as condoms for 30 days after treatment, and using highly effective contraception and avoiding fathering children for at least six months after treatment if your partner could become pregnant.

Do you need a catheter after Optilume?

Yes. A catheter is usually left in for a few days after the balloon treatment and removed at a follow-up appointment.

The procedure itself is endoscopic, under general or spinal anaesthetic, and usually a day case. A telescope is passed into the urethra, a guidewire is placed across the narrowing, and the balloon is inflated for a set period before being removed; some strictures are incised first. Afterwards, expect stinging and some blood in the urine for a few days to a couple of weeks. Most men return to normal activities within a few days of the catheter coming out, and to sport and heavy activity within one to two weeks.

Is urethroplasty major surgery?

Yes. It is open reconstructive surgery under general anaesthetic, usually with one or two nights in hospital — but it is designed to be done once, not repeated.

The incision is usually in the perineum, behind the scrotum, for bulbar disease, or on the penis for penile disease. The operation is chosen to fit the stricture: excision and primary anastomosis for short bulbar strictures, non-transecting repairs that preserve the urethra’s blood supply, or graft augmentation, which opens the narrowed segment and lets in a patch of tissue, most often buccal mucosa from inside the cheek. Long strictures involving most of the urethra can be repaired in one stage by the Kulkarni approach, and severely scarred urethras in two stages several months apart.

BAUS quotes a long-term success rate of more than 85% for bulbar urethroplasty, and notes that it is done in specialist reconstructive referral centres. That is the case for it: a bigger operation once, rather than a smaller one repeatedly and indefinitely.

How bad is urethroplasty recovery?

The main inconvenience is a catheter for two to three weeks. Most men return to desk work within two to three weeks and to full activity at around six weeks.

Before the catheter comes out, a contrast X-ray checks that the repair has healed and is watertight. If it has not quite healed, the catheter stays a little longer, which is common and not a cause for alarm. Heavy lifting, cycling and strenuous exercise are avoided for around six weeks. If a graft has been taken from your cheek, your mouth will be sore for one to two weeks, and you will be given advice on a soft diet and mouth care.

How risky is urethroplasty?

The risks include bleeding, infection, urinary leak, recurrence and changes in ejaculation; erectile dysfunction is uncommon and usually temporary.

Other risks include wound problems, altered sensation, and penile shortening or curvature with certain techniques. Changes in ejaculation, such as reduced force or dribbling afterwards, are more common than erectile problems and generally settle. Non-transecting techniques are used specifically to reduce the risk to erections. Problems at the donor site in the mouth are usually minor and short-lived.

Weigh these against the alternatives rather than against nothing. Optilume’s risks include urinary infection, blood in the urine, pain on passing urine, temporary retention and recurrence, and with repeated endoscopic treatment it is recurrence that accumulates.

Can I just leave a stricture alone?

Sometimes. If symptoms are mild and tests show your bladder is emptying safely, monitoring is reasonable, but that decision should follow proper assessment.

Left untreated, ongoing obstruction makes the bladder work against resistance, which over time can cause thickening of the bladder muscle, incomplete emptying, stones, recurrent infection and, in severe cases, kidney damage. Complete inability to pass urine is a medical emergency. For men who are not suitable for reconstruction, or who do not want it, regular self-catheterisation can keep a dilated stricture open for years, and most men manage it easily once taught.

How do I get my stricture properly assessed?

Book a consultation at which the stricture can be mapped; the choice of treatment should follow from that assessment, not come before it.

I see men with stricture disease at my clinic at The Shard, and I set up and lead the Southeast London Urethral Reconstruction Team at Guy’s Hospital, established in 2012. I perform endoscopic treatment, Optilume and the full range of urethroplasty, so the recommendation follows your stricture rather than the equipment available. Contact my team to arrange an appointment.

Sources and further reading

1. BAUS: General information about urethral stricture disease (patient leaflet, published Mar 2024)
2. BAUS: Urethroplasty (bulbar) (patient leaflet, published Mar 2024)
3. BAUS: Endoscopic treatment of urethral stricture (patient leaflet, published Mar 2024)
4. Bradford Teaching Hospitals NHS Foundation Trust: Optilume balloon dilatation for anterior urethral strictures