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Overview | Treatment | Surgery | Precautions | After Surgery Care
Urethral Stricture
Urethral Stricture OVERVIEW
The urethra is a tube that carries urine from the bladder so it can be expelled from the body.
Usually, the urethra is wide enough for urine to flow freely through it. When the urethra narrows, it can restrict urinary flow. This is known as a urethral stricture.
Urethral stricture is a medical condition that mainly affects men.
Causes
Men are more likely to have a urethral disease or injury because of their longer urethra. For this reason, strictures are more common in men. They are rare in women and in infants.
Stricture (narrowing of the urethra) can happen at any point from the bladder to the tip of the penis. This narrowing restricts or slows the flow of urine. Some common causes are:trauma to the urethra
- infection such as a sexually transmitted disease
- damage from surgical tools
- conditions that cause swelling
Rare causes include:
- a tumor located in close proximity to the urethra
- untreated or repetitive urinary tract infections
- the sexually transmitted infections (STIs) gonorrhea or chlamydia
In most cases, no cause can be found.
In adults, urethral strictures are most often due to:
- injury from a fall onto the scrotum or perineum
- prostate surgery
- kidney stone removal
- urinary catheterization
- other surgical tools
Posterior Urethral Stricture
Posterior urethral strictures happen in the first 1″ to 2″ of the urethra. This kind of stricture is due to an injury linked to a pelvic fracture (e.g., motor vehicle or industrial accident). In these cases, the urethra is disrupted, or completely cut and separated. Urine cannot pass. A catheter must be placed either through the abdomen into the bladder (suprapubic tube), or through the penis into the bladder. This lets urine drain until the stricture can be fixed.
Anterior Urethral Stricture
Anterior urethral strictures happen in the last 9″ to 10″ of the urethra. This kind of stricture is caused by:
- trauma from a straddle injury (from falls onto objects where the legs are on either side)
- direct trauma to the penis
- catheterization
What are the risk factors for urethral stricture?
Some men have an elevated risk of developing urethral stricture, especially those who have:
Prevention
- Avoid injury to the urethra and pelvis.
- Be careful with self-catheterization
- Use lubricating jelly liberally
- Use the smallest possible catheter needed for the shortest time
- Avoid sexually transmitted infections.
- Gonorrhea was once the most common cause of strictures.
- Antibiotics have helped to prevent this.
- Chlamydia is now the more common cause.
- Infection can be prevented with condom use, or by avoiding sex with infected partners.
- If a problem occurs, take the right antibiotics early. Urethral strictures are not contagious, but sexually transmitted infections are.
What are the symptoms of Urethral Stricture?
Urethral stricture can cause numerous symptoms, ranging from mild to severe. Some of the signs of a urethral stricture include:
- weak urine flow or reduction in the volume of urine
- sudden, frequent urges to urinate
- a feeling of incomplete bladder emptying after urination
- frequent starting and stopping urinary stream
- pain or burning during urination
- inability to control urination (incontinence)
- pain in the pelvic or lower abdominal area
- urethral discharge
- penile swelling and pain
- presence of blood in the semen or urine
- darkening of the urine
- inability to urinate (this is very serious and requires immediate medical attention)
Diagnosis Plan
A patient needs to undergo basic blood and urine tests apart from abdominal sonography. A urinalysis and a urine culture are done to rule out urinary infections. Tests may be done for Chlamydia, gonorrhea, and other sexually transmitted diseases. Urinary flow rates are measured. An X-ray (Ascending Urethrography) confirms the diagnosis, wherein contrast medium is injected into the urethral tube to outline the urethra and to define the extent of the stricture. Cystoscopy (telescopic inspection of the urethra and bladder) that is done during treatment will finally confirm the diagnosis.
Method
The doctor will take a full medical history to help diagnose the underlying cause of urethral strictures.
They will ask about a person’s symptoms, when they started, and what makes them worse or better.
For males, a doctor will also conduct a physical exam to see whether there are any visible injuries or deformities to the penis. They may also recommend various testing methods to identify urethral problems. Tests include:
- Urethroscopy: During this test, a doctor inserts a thin lighted scope into the urethra to see where the urethral stricture has occurred.
- Retrograde urethrogram: In a retrograde urethrogram, a doctor inserts special contrast dye into the urethra at the tip of the penis and watches where the dye progresses using a fluoroscopic X-ray device.
- Imaging studies: Imaging studies, such as MRI scans, CT scans, and ultrasounds, let doctors view the urethra and surrounding structures.
A doctor will use information from diagnostic studies to determine the severity of the urethral stricture and how it impacts surrounding structures.
Treatment methods
There are many options depending on the size of the blockage and how much scar tissue is involved.
Treatments include:
- dilation – enlarging the stricture with gradual stretching
- urethrotomy – cutting the stricture with a laser or knife through a scope
- open surgery – surgical removal of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty)
There are no available drugs to help treat strictures.
Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can’t pass urine), which could lead to an enlarged bladder and kidney problems.
Dilation
This is usually performed in the urologist’s office with local anesthesia. The stricture is stretched using larger and larger dilators called “sounds.” A special balloon on a catheter can also stretch the tissue. But this stretching is not really a cure and needs to be repeated regularly. If the stricture comes back too quickly, you may be taught how to insert a catheter from time to time to prevent it from coming back. Side effects include bleeding and infection. Sometimes a “false passage” or second urethral channel may form from the stretching.
Urethrotomy
This uses a special scope that is moved along the urethra until the stricture is found.
A knife blade or laser at the end of the cystoscope is used to cut the stricture and create a gap. A catheter may be placed into the urethra to hold the gap open and let it heal. The suggested time to leave a catheter tube draining is based on the length of the stricture.
Open Surgery
Many reconstructive procedures have been used to treat strictures, and some involve 1 or 2 operations. In all cases, the choice of repair is based on the location and length of the stricture and how serious it is. No single repair is right for all cases. The 2 main types are anastomotic urethroplasty and substitution urethroplasty.
Anastomotic Urethroplasty
This method is usually reserved for short urethral strictures. In this case, a cut is made between the scrotum and rectum. The urethra can then be reconnected after removing the stricture. This is usually performed as an outpatient procedure or with a short hospital stay. A small, soft catheter is left in the penis for 10 to 21 days. It is then removed after an X-ray is taken to make sure the repair has healed.
Substitution Urethroplasty
When the stricture is long, tissue can be transferred to replace the section that had the stricture. In difficult cases, substitution repairs may need to be done in stages. These repairs should be done by a urologist experienced with these surgeries. Overall the success rates are very good. The 3 kinds of substitution procedures are:
- Free graft
- Skin flap
- Staged
Free Graft
This method replaces or enlarges a section of the urethra using your own tissue. The tissue may be skin (taken from the shaft of the penis) or, more often, buccal mucosa (taken from inside the cheek). After surgery, you may need a short hospital stay and use a catheter for 2 or 3 weeks.
Skin Flap
With this surgery, flaps of skin are rotated from the penis to create the new section of the urethra. This is needed when a graft needs to be long, and the stricture is severe. These procedures are complex and should be done by a surgeon with plastic surgery experience. After surgery, you may need a short hospital stay and use a catheter for 2 or 3 weeks.
Staged
This method is used when local tissue will not work for a free graft or a skin flap.
First stage – The underside of the urethra is opened, which shows the full length of the stricture. A graft is secured to the opened urethra. The graft heals and matures for 3 months to a year. During that time, you will urinate through a new opening behind the stricture. This may mean that you have to sit down to urinate while the graft heals.
Second stage – Several months after the graft around the urethra has healed, and it is soft and flexible, the graft is formed into a tube. The urethra then returns to normal. A small, soft catheter is left in the penis for 10 to 21 days
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FAQ
What type of doctor treats urethral obstruction?
Most commonly, urethral strictures are managed by urologists, who are doctors with training and specialization in the urinary system.
What is the outlook for urethral stricture?
Urethral stricture has a generally positive outcome. It is a treatable condition. However, this condition can happen again, requiring multiple procedures. Follow-up appointments with your healthcare professional will be needed after being treated for urethral stricture.
How do I prevent urethral stricture?
By avoiding injury to the pelvic area of the body, it may be possible to prevent some forms of urethral stricture. Taking care to avoid infection may also help prevent this condition.
How long does a urethral stricture dilation last?
These symptoms should get better in 1 or 2 days. You will probably be able to go back to most of your usual activities in 1 or 2 days. Drink extra water for the next few days. This care sheet gives you a general idea about how long it will take for you to recover. obstruction, you should drink plenty of water and limit your sodium (salt) intake.
Can you live with a urethral stricture?
If left untreated, a urethral stricture can cause serious problems, including bladder and kidney damage, infections caused by the obstruction of urine flow, and poor ejaculation and infertility in men. Fortunately, strictures can be successfully treated.
DR. ANAND UTTURE
MCh - Urology/Genito-Urinary Surgery, DNB - Urology/Genito - Urinary Surgery, MBBS, FICS, MS - General Surgery
Dr Anand Utture is a Senior Urologist who is internationally recognized for his surgical expertise and academic contribution to the field of Urology.
Book AppointmentWhen to see a Urologist Doctor
Make an appointment with your doctor if you have any signs and symptoms that worry you.
Seek immediate medical attention if you experience:
- Pain so severe that you can’t sit still or find a comfortable position
- Pain accompanied by nausea and vomiting
- Pain accompanied by fever and chills
- Blood in your urine
- Difficulty passing urine