A urethral stricture is a formation of scar tissue anywhere along the urethra that results in a narrowing of the lumen, the cavity of the urethra. This results from some form of inflammation in the urethra. Symptoms of a urethral stricture may not develop until several years after the initial event. This disease process can occur in both males and females, however, it is more common in males as the urethral length is longer.
The human urinary tract begins at the kidneys and ends with the urethra. The urethra begins at the bladder opening and allows the passage of urine from where it is stored in the bladder to the outside of the body. In both men and women, there is an external sphincter that is part of the pelvic floor. This clamps down to prevent leakage of urine. In men, the urethra runs through the entire length of the penis and therefore is a longer structure than in women.
- Urethral strictures can be silent, causing no symptoms.
- If left untreated, strictures may weaken the bladder muscle over time. This can lead to kidney damage.
- Strictures most often occur later in life, not typically present at birth.
- Surgical procedures are the best treatment options.
What are some symptoms of urethral stricture?
- Weak urine flow
- After urination, the bladder does not feel empty
- Spraying of the urine stream or splitting of the stream
- Burning sensation or discomfort during urination
- Presence of blood inside the urine and semen
- Painful ejaculation
- Urethral discharge
- Sudden urge to urinate
- Strong desire to urinate but the inability to produce a urine stream. This can be dangerous and may require immediate medical attention.
What are some causes of urethral stricture?
Urethral stricture occurs because of tissue inflammation inside the urethra, which eventually becomes a scar. This can occur anywhere along the length of the urethra. One of the more common causes for urethral strictures is related to some sort of trauma, either accidental or procedural. It can develop after a single event or several minor injuries throughout a patient’s life.
Some other causes include:
- Radiation
- Pelvic fracture
- Prior instrumentation of the urethra (foley catheter)
- Recent prostate surgery
- Urinary tract infections
- A tumor located within or in the proximity of the urethra
- Sexually transmitted infections such as chlamydia or gonorrhea
- Lichen sclerosus (balanitis xerotica obliterans)
What tests are used in the evaluation of a urethral stricture?
Cystourethroscopy
A small telescopic camera is used to evaluate the urethra and bladder. This test may cause mild discomfort. It allows for direct visualization of the disease.
Retrograde Urethrogram
Radiographic dye is injected through the urethra with a blunt syringe or catheter. Radiographic images are taken, which will identify areas of disease and may help with identifying the length of the stricture. This test is minimally invasive but can cause some mild discomfort.
Voiding Cystourethrogram
This test can be done at the same time as a retrograde urethrogram. The bladder is filled with radiographic dye through a very small catheter. The patient will be instructed to urinate while radiographic images are taken. This is helpful when dye from a retrograde urethrogram is unable to pass easily through the stricture.
What treatments are available for urethral stricture?
Once a stricture develops inside your urethra, it does not go away spontaneously. Medications do not treat the disease, but they can be helpful with managing symptoms. Surgical procedures are the most effective form of treatment.
Urethral Dilation
This procedure manually widens the scar within the urethra by passing rods through the diseased area. This procedure may not be curative for the stricture disease, and therefore may require repeat treatment to keep the urethra open. It can be done while the patient is awake with local anesthetic or asleep with general anesthesia.
Direct Vision Internal Urethrotomy
DVIU is a procedure performed under general anesthesia. A telescopic camera is used to visualize the stricture within the urethra. A tiny knife or a laser fiber is used to cut into the stricture, widening the urethral caliber. A catheter is then inserted into the urethra and remains there for 1-2 weeks to allow the area to heal.
For a first-time urethral stricture that is mild to moderate, this has about a 70% success rate. If the stricture returns, a repeat DVIU is unlikely to have lasting success.
Suprapubic Catheter Placement
The urethral stricture may be severe enough that the options above are not possible. A catheter can be placed directly into the bladder through the lower abdomen to drain the bladder. This is generally used as a temporary solution.
Urethroplasty
Urethroplasty is an open surgical procedure requiring general anesthesia. The aim is to remove a portion or all of the scarred tissue and reconstruct the urethra to allow for better urine flow. An incision is made from the skin down to the area of disease. If the stricture is short, we will attempt to remove all the scarred urethra and connect the two healthy ends of the urethra together. If the stricture is long, we will remove a portion of the scar and use tissue from another location on the body.