A urethral stricture is scarring in or around the urethra or a narrowing of the opening of the urethra, which can block the flow of urine. Urethral strictures are usually the result of inflammation, injury or infection.
Who's At Risk?
Women rarely develop urethral strictures, which are more common in men, whose urethras are longer and more prone to injury and infection. Nearly half of all cases of urethral strictures are caused by inflammation or injury from repeated medical procedures such as catheters or surgery.
If you're prone to developing infections of the urethra, such as urethritis or urinary tract infections, you're more susceptible to developing urethral stricture.
Individuals with poor hygiene or who engage in risky sexual behaviors are also more likely to suffer from urethral strictures.
Symptoms of Urethral Stricture
Some cases of urethral stricture don't exhibit any symptoms, while others can range from mild discomfort to complete urinary retention. Common symptoms of urethral stricture may include:
urinary tract infection
slow urine stream
decreased urine output
spraying or dribbling of the urine stream
blood in the urine ("hematuria")
Diagnosing Urethral Stricture
Diagnostic tests such as urinalysis (UA), urine culture and urethral culture for sexually transmitted diseases like gonorrhea, chlamydia can be ordered to determine if you have urethral strictures. Imaging and endoscopic studies are sometimes necessary to confirm the diagnosis and identify the cause of urethral strictures. Common imaging and endoscopic tests to evaluate urethral strictures include ultrasound of the urethra, retrograde urethrogram, anterograde cystourethrogram and cystourethroscopy.
Treating Urethral Stricture
Medication can help manage urethral strictures, but the only real treatment for curing severe cases is surgery. Many people with urethral strictures can function normally without intervention, but surgery is generally recommended if you suffer from the following circumstances:
severe problems with urination and urinary retention
kidney stones in the bladder
recurrent urinary tract infections
increasing amount of urine left in bladder after urination
failure of medication to control your pain
A number of surgical procedures are available for treating urethral strictures. Depending on your specific case, your doctor will recommend the most appropriate procedure for you. Beaumont is one of the few health systems in Michigan who have fellowship-trained urologists who are experts in the repair of complex urethral strictures.
Urethral dilation is a commonly used technique for treating urethral strictures. It is typically performed under local or general anesthesia. Thin rods of increasing diameters are gently inserted into the urethra in order to open the urethral narrowing without causing further injury. This procedure may need to be repeated from time to time, as strictures recur. The shorter the stricture, the less likely it is to recur after a dilation procedure. Occasionally, patients are given instructions and dilation instruments (rods, lubricating gel, and anesthetic gel) to perform urethral dilation at home.
An urethrostomy is an endoscopic procedure typically performed under general anesthesia. A thin tube with a camera (endoscope) is inserted into the urethra to visualize the stricture. Then a tiny knife is passed through the endoscope to cut the stricture lengthwise and open the flow of urine. A Foley catheter is then inserted and kept in place for a few days while the urethral incision heals. The success rate of this procedure is about 25 percent, with shorter strictures generally responding better to this procedure.
Urethral stent placement
Urethral stent placement is another endoscopic procedure where a closed tube (stent) is passed through an endoscope to the area of the stricture. Once it reaches the proper location, the stent can be opened to form a tube to enable urine to flow.
Open urethral reconstruction
Open reconstruction can involve several surgical techniques that involve opening the urethra under general anesthesia to fix the stricture. In some surgeries, the area of scarring is cut out and the remaining urethra reconnected. In others, after the scar tissue is removed, a graft may be used to form a reconstructed urethra. These techniques, in general, have a good response rate, although they're more invasive than other described procedures.
Preventing Urethral Stricture
Urethral strictures can be caused by STDs and bacterial infections, so practicing safe sex and proper hygiene can help prevent some cases. However, since most cases of urethral strictures are caused by injury, trauma or repeated medical procedures, they are difficult to avoid for high-risk patients.