Prof. Dr. Emel Akoğlu
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- 57+years exp.
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Kidney & Bladder
Drug coated balloon urethral dilatation
What drug coated balloon urethral dilatation is, how a paclitaxel-coated balloon widens a urethral stricture and helps stop it narrowing again, what the trials show, who is and is not suited, how it compares with dilatation, urethrotomy and urethroplasty, approximate costs in Turkey against the UK, US and Germany, recovery, risks and questions to ask.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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Drug coated balloon urethral dilatation: what it is and how it works
A urethral stricture is a scar-like narrowing of the urethra, the tube that carries urine out of the bladder. It causes a weak or split urine stream, straining, a feeling of incomplete emptying, repeated urinary infections and sometimes retention. Drug coated balloon urethral dilatation is a minimally invasive treatment for a short stricture in which a balloon, coated with the anti-scarring drug paclitaxel, is placed across the narrowing under camera guidance and inflated. The balloon stretches the stricture open, and at the same time presses a thin layer of the drug into the wall of the urethra. The drug is intended to slow the growth of scar tissue that makes strictures come back, which is the main weakness of ordinary dilatation.
This guide explains who the treatment is for, what the evidence shows, how it compares with standard dilatation, urethrotomy and urethroplasty, what it costs compared with the UK, US and Germany and what to ask a urologist in Turkey. For the wider range of procedures see our overview of urology treatments in Turkey.
How is a drug coated balloon used step by step?
The procedure is usually done under spinal or general anaesthesia, or sometimes local anaesthetic with sedation, and takes about 20 to 45 minutes. First the urologist looks into the urethra with a thin camera, a flexible or rigid cystoscope, and measures the length and position of the stricture. A guidewire is passed through the narrowing into the bladder. Often the stricture is first cut or opened slightly. The balloon is then pushed along the wire, centred on the stricture, and inflated for a set time, usually a few minutes, so that the drug transfers to the tissue. It is then deflated and removed, and a catheter is normally left in the bladder for a short period, from a day to a few days depending on the surgeon.
Does drug coated balloon urethral dilatation work?
The balloon opens the stricture at once, and the concern is how long it stays open. Early studies and the randomised ROBUST III trial in men with recurrent strictures in the bulb of the urethra found that, at 12 months, a higher share of men treated with a paclitaxel-coated balloon had no need for another procedure and better urine flow and symptom scores than men treated with standard dilatation or urethrotomy. The device has regulatory approval in the United States for short bulbar strictures in adults. The evidence is still newer than that for urethroplasty, long-term results beyond several years are limited, and it has been studied mostly in short strictures. It is therefore a reasonable option in selected men, not a replacement for surgery in all cases.
Who is a good candidate, and who is not?
Good candidates are adult men with a short, single stricture (usually under about 3 cm) in the bulbar urethra, particularly after earlier dilatation or urethrotomy has failed. It is less suited to long or multiple strictures, a stricture that is very tight, completely blocked or affected by a fistula, a stricture in the penile urethra, and active urinary infection that has not been treated. Your urologist will assess it with a urine flow test, a retrograde urethrogram (X-ray with contrast) and a cystoscopy. If the stricture is too long, urethroplasty may be advised, and the surgeon should tell you honestly if the balloon is not right for you. Women and children are not the usual group for this device.
Balloon, urethrotomy or urethroplasty: how do they compare?
| Treatment | Best suited to | Typical limits |
|---|---|---|
| Simple dilatation | First-time short stricture, frail patients | High recurrence; often repeated |
| Internal urethrotomy (cutting the stricture) | First-time short strictures; see internal urethrotomy | Recurrence is common, especially after the first attempt |
| Drug coated balloon | Short recurrent bulbar strictures | Limited long-term data; not for long strictures; may still recur |
| Urethroplasty (open reconstruction) | Long, complex or repeatedly recurrent strictures; see urethroplasty | Larger operation, longer recovery, higher cost |
Guidelines from the European Association of Urology and the American Urological Association note that repeated dilatation or urethrotomy rarely cures a stricture and that urethroplasty gives the highest long-term success in suitable patients. A drug coated balloon sits between the two for short strictures. A surgeon should explain why they favour one approach and what you can expect.
How much does drug coated balloon urethral dilatation cost in Turkey?
The figures below are approximate ranges for the whole procedure, not hospital quotes. The balloon is a single-use, relatively expensive device, so the price of the procedure is higher than simple dilatation. It also depends on the type of anaesthesia, whether the stricture is first cut, the hospital stay and the catheter period.
| Country | Approximate cost range |
|---|---|
| Turkey | €2,000 – €6,000 |
| United Kingdom | €4,500 – €10,000 |
| United States | €9,000 – €28,000 |
| Germany | €3,500 – €9,000 |
Check that the quote for drug coated balloon urethral dilatation lists the device, the anaesthesia, the hospital stay, the pre-procedure tests (urine culture, flow test, urethrogram, cystoscopy) and the follow-up. A package should state what happens if the stricture comes back soon after you leave.
What does the procedure feel like?
You are anaesthetised or sedated, so you should not feel the balloon being inflated. Afterwards a catheter feels like a constant need to pass urine, and there can be burning when you pass urine, mild blood in the urine and some discomfort in the lower abdomen or perineum. These are usually controlled with simple painkillers and settle within days. Drink plenty of water to keep urine dilute and clear.
Recovery after drug coated balloon urethral dilatation
Most men go home the same day or after one night. The catheter is usually removed after 1 to 3 days, though your surgeon may leave it longer. Expect a stronger stream soon after removal. Many men return to desk work within a few days and avoid strenuous exercise, cycling and sexual activity for about one to two weeks, or as advised. You will normally be asked to do a flow test and symptom review at around three months and later. Plan to stay in Turkey until the catheter is out, the first voiding is checked and the surgeon is satisfied; that is usually two to four nights. Flying is generally fine once you are passing urine well. Because strictures can return, regular follow-up in your home country matters; ask for the operation report, the stricture length and the device details.
Risks and complications
Most men have mild blood in the urine, burning and urgency for a few days. Less common are urinary tract infection, retention after catheter removal, a stricture that comes back, pain or bleeding that needs further treatment, and, rarely, urethral injury or a false passage. Because paclitaxel is a cancer drug, patients sometimes ask about safety; the dose delivered locally by the balloon is very small and the trials did not show a safety signal, but long-term data are still being collected, and you should discuss it with the urologist. Tell the team about previous allergic reactions, blood thinners and recent infections. Professional bodies such as the European Association of Urology advise follow-up for several months after any stricture treatment.
How to choose a urologist and hospital, and red flags
Look for a urologist who treats strictures regularly, offers urethroplasty as well as endoscopic treatment, and who will review your urethrogram and flow test before recommending the balloon. The hospital should be licensed, with an anaesthetist and the equipment for cystoscopy and X-ray. Red flags include a quote with no assessment of stricture length, a promise that the stricture will never return, no follow-up plan and no mention of alternatives. Read how our process works and use the free quote page to send your reports. If a diagnostic look inside is all you need, see cystoscopy.
Questions to ask the urologist:
- How long and where is my stricture, and is the balloon suitable?
- Would urethroplasty be a better long-term option for me?
- How many men with strictures have you treated with this balloon?
- How long will the catheter stay, and how many days must I stay in Turkey?
- What follow-up is advised, and who will do the flow tests at home?
- What happens if the stricture recurs?
Hospitals with Urology in Turkey
Frequently asked questions
It is a treatment for a short urethral stricture in which a balloon coated with paclitaxel is inflated across the narrowing. It stretches the urethra open and delivers a drug intended to reduce scar tissue regrowth.
In a randomised trial of recurrent bulbar strictures, more men treated with the coated balloon avoided repeat procedures at 12 months than with standard dilatation or urethrotomy. Long-term data beyond several years are limited.
Approximate ranges are €2,000 to €6,000 in Turkey, against about €4,500 to €10,000 in the UK. The price depends on the device, anaesthesia and hospital stay, and the hospital confirms it in a written quote.
It is done under spinal, general or local anaesthesia with sedation, so you should not feel the balloon. Afterwards the catheter and burning when passing urine can be uncomfortable for a few days.
Most men go home the same day or the next, the catheter comes out after one to three days and many return to desk work within a few days. Strenuous exercise is usually avoided for one to two weeks.
Yes. The coating is intended to lower the chance, but strictures can recur, and regular follow-up with flow tests is advised. If it does, urethroplasty may be considered.
For short recurrent bulbar strictures, trial results suggest fewer repeat procedures than urethrotomy at 12 months. Neither is right for every man, and urethroplasty is more durable for long or complex strictures.
Men with long or multiple strictures, a completely blocked urethra, strictures in the penile urethra or an untreated urinary infection are usually advised other treatment. A urethrogram and cystoscopy decide suitability.
The amount delivered locally is very small and trials have not shown a safety concern, but long-term data are still accumulating. Discuss the question and your medical history with your urologist.
Plan for about two to four nights, so the catheter can be removed and your first urination checked before you fly. Your urologist confirms the exact length after the operation.
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