Table of ContentsView AllTable of ContentsSymptomsCausesRisk FactorsPreventionDiagnosisSurgical TreatmentRisksNon-Surgical Treatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Risk Factors
Prevention
Diagnosis
Surgical Treatment
Risks
Non-Surgical Treatment
A urethralstrictureis a narrowing of the urethra, the tube through which urine leaves the bladder and exits the body. A scar in the urethra from swelling, previous procedures, injury, or infection may cause a urethral stricture and block or slow the flow of urine in the urethra. This often causes difficulty with passing urine, including straining andpain in the urethra.
Urethral strictures are most common in men but can occur in women as well. Men over the age of 55 are most prone to urethral strictures.
This article discusses the symptoms, causes, and diagnosis of urethral stricture, as well as treatment options and ways to prevent it.
Symptoms of Urethral Stricture
In males, the urethra is on average 10 inches from the end of the bladder to the tip of the penis. The first 1-2 inches of the urethra is called the posterior urethra and the rest of the urethra is called the anterior urethra. Strictures can occur in both the posterior and anterior urethra.The path to diagnosis of strictures is fairly uniform but the treatment can vary based on where the stricture is located.
A urethral stricture can cause mild to severe issues with urination. These symptoms include:
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What Are the Main Causes of Urethral Stricture?
There are many reasons why a urethral stricture may occur. Some patients may never know what the initial cause of the stricture was, while others may experience a stricture as a side effect of certain surgeries.
Types of Stricture
There are four general types of urethral stricture:
Iatrogenic Causes
Swelling or scarring can occur from any procedure or instrumentation on the urethra. It’s important to ask your healthcare provider about the risks of any procedures that may include risks to the urethra.
Transurethral resection of the prostate, also known as a TURP procedure, can cause scarring of the urethra, as can any procedure that requires instruments to be inserted into the urethra.
Cystoscopy, transurethral bladder procedures, and endoscopic kidney procedures are also procedures known to increase the risk of urethral strictures. The use of urinary catheters, such as a Foley or straight catheter, can lead to urinary strictures, particularly when used for extended periods of time.
Traumatic Causes
Injury may cause damage to the urethra, and during or after healing symptoms may start. Pelvic fractures and perineal trauma are commonly associated with urethral strictures.
Inflammatory Causes
Inflammatory causes of urethral stricture include:
Congenital strictures—strictures present at birth—are far less common than strictures that occur later in life, but they are also possible.
While urethral strictures are far more common in men, they do occur in women and children. Males with urethral stricture may have a history of the following:
Common Risk FactorsSexually transmitted infections (STI), includinggonorrheaUrinary tract infections (UTI)Procedures that take place in or through the urethraUrethritis—inflammation of the urethraPelvis fractureor trauma
Common Risk Factors
Sexually transmitted infections (STI), includinggonorrheaUrinary tract infections (UTI)Procedures that take place in or through the urethraUrethritis—inflammation of the urethraPelvis fractureor trauma
Avoid sexually transmitted and other types of urinary tract infections, but more importantly, seek treatment quickly if one is suspected since antibiotics help reduce the risk of stricture.
How Is Urethral Stricture Diagnosed?
Urethroscopyis a procedure using a fiber optic scope to look in the urethra when a stricture is suspected. A retrograde urethrogram is a procedure where contrast dye is injected into the urethra to see how many strictures there are, and their position, length, and severity.The urethrogram is typically done for patients who have had a pelvic fracture or trauma and is often used to determine if surgery may be necessary.
Treatment may be done on an emergent basis for a stricture that is causing a complete inability to urinate or when found incidentally during planned surgical procedures.
Options for treatment of urethral strictures primarily involve surgery, including:
Urethrotomy
Aurethrotomy, also known as a Direct Visualization Internal Urethrotomy (DVIU), is a minimally invasive procedure where a cystoscope (rigid instrument used to look inside the bladder), balloon, laser, or sharp instrument is used to open the stricture so that it no longer stops the flow of urine through the urethra.
Some of these procedures can be done in the office or bedside using local anesthesia in emergency situations. During a planned procedure your healthcare provider may choose to use general anesthesia or twilight sleep.
Once the procedure is complete, you would likely go home with aFoley catheter(tube with a balloon that stays in your bladder and urethra to drain your urine) to help with recovery. The Foley does the job of draining urine but also helps keep the newly released strictures open. It is removed a few days later. At this point, your healthcare provider may teach you how to catheterize yourself to keep the stricture open or discuss other more invasive procedures.
In emergencies, or when your healthcare provider can not get past the stricture, they may opt to place a suprapubic tube to drain the bladder. This is a type of catheter that is placed in the bladder through an incision made in the abdomen.
Urethroplasty
The urethroplasty, also known as “open surgery,” is the surgical removal of the stricture with the reconstruction of the urethra. While this procedure is more involved and far more complex than other treatments, it is thought to have the best long-term outcomes and lowest rate of reoccurrence.
There are multiple types of urethroplasty, depending on the location of the stricture in the urethra, the severity, and the cause of the issue.
The procedure may start with the placement of a suprapubic catheter, which diverts urine away from the urethra so the procedure can be performed.
The procedure then may include the harvesting of tissue from the inside of the cheek of the patient or from the penis, if the surgeon believes extra tissue will be needed to reconstruct the urethra.If the tissue is not expected to be needed, the surgeon may proceed to surgically release the narrowed area in the urethra once it has been numbed with medication.
Once the urethra is exposed, the area with the narrowing can be cut open, with the harvested tissue used to create a larger urethra. The area is closed and the surgeon checks for good blood flow in the area.
Recovery From SurgeryMost people can return to their normal activities within a few weeks of surgery. Most regain the ability to urinate without difficulty, but a rare few will have the stricture return in the future. Some degree of erectile dysfunction is common, but this tends to resolve within 12 months.The urethrotomy is almost always done expecting to retreat the patient in the future, as very few patients have long-term relief from the procedure. In some cases, the urethrotomy is done to buy time, such as waiting for a pediatric patient to grow for a few more years before making a final decision about how to address the issue permanently.
Recovery From Surgery
Most people can return to their normal activities within a few weeks of surgery. Most regain the ability to urinate without difficulty, but a rare few will have the stricture return in the future. Some degree of erectile dysfunction is common, but this tends to resolve within 12 months.The urethrotomy is almost always done expecting to retreat the patient in the future, as very few patients have long-term relief from the procedure. In some cases, the urethrotomy is done to buy time, such as waiting for a pediatric patient to grow for a few more years before making a final decision about how to address the issue permanently.
Most people can return to their normal activities within a few weeks of surgery. Most regain the ability to urinate without difficulty, but a rare few will have the stricture return in the future. Some degree of erectile dysfunction is common, but this tends to resolve within 12 months.
The urethrotomy is almost always done expecting to retreat the patient in the future, as very few patients have long-term relief from the procedure. In some cases, the urethrotomy is done to buy time, such as waiting for a pediatric patient to grow for a few more years before making a final decision about how to address the issue permanently.
Risks of Surgical Treatment
All surgeries have risks, including thegeneral risksassociated with any surgery and the risk that is associated withanesthesia. The surgical procedures done to treat urethral strictures have additional risks specific to this type of procedure.
There are two potential complications that patients should be aware of, as they can be present in up to 20% of surgery patients:
Perineal hematoma:This is a collection of blood in the area between the scrotum and anus. Worse than a bruise, thehematomacan be tender or even painful and may take weeks to resolve completely. This can occur after urethroplasty procedures.Urethral bleeding:This complication is often present in urethral stricture treatment, but ranges from minor bleeding to significant bleeding, with serious bleeding being far less common.
Other potential complications include urinary incontinence or urinary retention, erectile dysfunction, retrograde ejaculation, decreased sensation in the penis, loss of penile length, and infection.
Non-surgical treatment is very limited, as there are no medications available currently to treat a urethral stricture. The only potentially effective treatment outside of surgery is dilation of the urethra using special rods called sounds that very gradually get larger from one end to the other.As the sound is gently advanced into the urethra, the tissue is stretched, a process that may gradually loosen the stricture.
While some people get some relief with this method, most require surgery to get significant, long-lasting relief or to prevent complications.
Summary
Urethral stricture is a narrowing of the urethra that can lead to significant problems urinating. In general, it is best to seek care immediately if you have difficulty urinating, since problems can range from minor to life-threatening, so a quick diagnosis along with prompt treatment is important.
While no medication can treat urinary strictures, several procedures are highly effective in treating the problem and provide fast relief.
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