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Urethral Stricture: Causes, Symptoms and Treatment
A urethral stricture is a narrowing of the urethra caused by scar tissue, which restricts urine flow. It can cause painful or difficult urination and requires medical evaluation.
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A urethral stricture is a narrowing of the urethra caused by scar tissue, which restricts urine flow. It can cause painful or difficult urination and requires medical evaluation.
What Is a Urethral Stricture?
A urethral stricture is an abnormal narrowing of the urethra, the tube that carries urine from the bladder out of the body. This narrowing is typically caused by scar tissue that forms inside the urethra, reducing its diameter and restricting the flow of urine. In severe cases, the urethra can become almost completely blocked. Urethral strictures are significantly more common in men than in women, largely due to the greater length and anatomical complexity of the male urethra.
Causes
A urethral stricture can develop from a variety of causes:
- Trauma and injury: Pelvic fractures, straddle injuries, or direct trauma to the perineum can damage the urethra and lead to scarring.
- Medical procedures: Urinary catheterization, endoscopic procedures, or urological surgery can cause scar tissue to form inside the urethra.
- Infections: Sexually transmitted infections such as gonorrhea and other forms of urethritis (inflammation of the urethra) are common infectious causes.
- Inflammatory conditions: Conditions such as lichen sclerosus can cause progressive scarring of the urethra.
- Radiation therapy: Pelvic radiation used to treat cancers such as prostate cancer can lead to urethral scarring.
- Congenital narrowing: In rare cases, urethral narrowing may be present from birth.
- Idiopathic causes: In some patients, no identifiable cause can be found.
Symptoms
Symptoms vary depending on the location and severity of the stricture. Common symptoms include:
- Weak or reduced urine stream
- Difficulty starting urination (hesitancy)
- Sensation of incomplete bladder emptying
- Frequent urge to urinate, including at night (nocturia)
- Pain or burning during urination (dysuria)
- Blood in the urine (hematuria) or in semen
- Recurrent urinary tract infections
- In severe cases: complete urinary retention, which is a medical emergency
Diagnosis
Several diagnostic methods are used to identify and assess a urethral stricture:
- Medical history and physical examination: A detailed account of symptoms, previous infections, injuries, or procedures is essential.
- Uroflowmetry: A non-invasive test that measures the rate of urine flow to assess the degree of obstruction.
- Urethrocystoscopy: A thin, flexible instrument (cystoscope) is passed through the urethra to directly visualize the stricture.
- Retrograde urethrography: An X-ray procedure using contrast dye to define the exact location, length, and severity of the stricture.
- Ultrasound: Imaging to assess the bladder and surrounding structures.
- Urinalysis and urine culture: To detect associated urinary tract infections.
Treatment
Treatment depends on the length, location, severity, and cause of the stricture, as well as the overall health of the patient.
Minimally Invasive Procedures
- Urethral dilation: Gradual widening of the narrowed segment using progressively larger instruments (bougies or balloons). This is a simple procedure but carries a high recurrence rate.
- Internal urethrotomy: The scar tissue is cut from the inside using an endoscopic instrument. It is most effective for short strictures but has a significant recurrence rate.
Surgical Procedures
- Urethroplasty: Surgical reconstruction of the urethra, considered the gold standard for longer or recurrent strictures. Depending on the extent of the stricture, the narrowed segment may be excised and the urethra re-joined (end-to-end anastomosis), or a tissue graft (commonly from the oral mucosa) may be used to widen the urethra.
- Urethral stent: A stent can be placed to keep the urethra open; however, this option is now rarely used and reserved for select patients.
Palliative Measures
- Indwelling urethral catheter or suprapubic catheter for patients who are not suitable candidates for surgery.
Prognosis and Follow-Up
The prognosis depends greatly on the chosen treatment and individual healing. Minimally invasive procedures are associated with high recurrence rates, often requiring repeated interventions. Urethroplasty offers the best long-term outcomes, with success rates exceeding 80-90%. Regular urological follow-up is recommended after any treatment to monitor for recurrence and ensure proper urinary function.
References
- Chapple C et al. - EAU Guidelines on Urethral Strictures. European Association of Urology (EAU), 2023. Available at: https://uroweb.org
- Mundy AR, Andrich DE. - Urethral strictures. BJU International, 107(1):6-26, 2011.
- Lumen N et al. - Etiology of urethral stricture disease in the 21st century. Journal of Urology, 182(3):983-987, 2009.
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