Urology Health Topics
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Urethral Strictures
The urethra is the tube that carries urine from the bladder (through the penis in males) to the outside of the body. A urethral stricture can occur anywhere in the urethra. A urethral stricture is a scarred area that causes narrowing of the caliber of the urethra. The stricture eventually reduces or obstructs the flow of urine out of the bladder, making it difficult to urinate. The bladder therefore must work harder to push the urine through the narrowed area of the urethra (the stricture).
There are many causes of urethral strictures:
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Trauma to the urethra or penis - blunt or penetrating urogenital trauma
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Urethral injury associated with traumatic pelvic fractures - motor vehicle accidents, falls, industrial injuries, etc.
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Straddle injury or direct trauma to the perineum (the area between the anus and scrotum)
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Recurrent urinary tract infections
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Sexually transmitted infections/diseases
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Lichen sclerosis (Balanitis Xerotica Obliterans or BXO)
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Congenital abnormalities of the urethra or penis
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Catheterization or instrumentation of the urethra
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Surgical procedures
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prior treatment for urethral diseases, such as urethral stricture or urethral cancer
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prior reconstructive surgery for congenital abnormalities of the urethra or penis (hypospadias, chordee, epispadias)
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prior gender reassignment surgery
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prior urologic surgery
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Unknown causes of urethral scarring (idiopathic)
If a urethral stricture is not treated appropriately, the increased strain on the bladder can damage and weaken the bladder muscle. This can lead to a number of serious health problems such as urinary retention (inability to pass urine), urinary incontinence (leakage of urine), inflammation or infection of the urinary tract, reflux (urine backs up into the kidneys), and kidney failure.
Symptoms and Signs:
Symptoms and signs of a urethral stricture may include a weak or slow urine stream, hesitation or trouble starting urination, taking a long time to urinate and empty the bladder, a sense of incomplete emptying, dribbling, urgency, irritation or burning during urination, urinary frequency, or urinary retention. Sometimes one may intermittently or continuously leak urine because the bladder is full beyond its capacity and overflow incontinence occurs. Sometimes a urethral stricture is diagnosed when a healthcare provider cannot insert a catheter through the urethra into the bladder.
Evaluation:
Evaluation of men with urethral injury or with a known or suspected urethral stricture may include a combination of:
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Physical examination
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Urinalysis, urine culture, urine cytology - examination of the urine for signs of infection, blood, and other abnormalities
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Uroflowmetry - mechanical measurement of urine output and flow rate
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Ultrasound postvoid residual -measures the left over urine in the bladder after one tries to empty completely
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Radiologic imaging – x-rays to identify anatomy of the urethra, bladder and urinary tract
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retrograde urethrogram (RUG)
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cystogram
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voiding cystourethrogram (VCUG)
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Ultrasound (US) to identify anatomy of the urethra, bladder and urinary tract
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Fiberoptic urethroscopy and cystoscopy
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visual inspection of the interior of the urethra and bladder using a flexible instrument (cystoscope) that is inserted into the urethra using local anesthesia
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Laboratory studies (blood tests) - BUN, creatinine, others
It is very important to have an accurate diagnosis and evaluation of the length and location of a urethral stricture. Once a urethral stricture is diagnosed, your urologist will determine any further evaluation that is needed. Options for treatment will be presented and discussed with you.
Several treatment options are available for men with urethral strictures. Some urethral strictures can be managed using a single procedure. If a stricture returns after one or more treatments, it is called a recurrent stricture. Without appropriate treatment, a stricture will recur almost 100% of the time. Strategies for prevention of a recurrent stricture will also be discussed with you.
Temporary Management:
Temporary management options for urethral strictures include:
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Catheterization (Foley or other type of catheter)
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a thin, flexible, plastic tube (catheter) is inserted into the urethra to temporarily drain urine from the bladder
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Suprapubic catheter
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a thin, flexible, plastic tube (catheter) is inserted into the bladder through the abdomen to temporarily drain urine
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Treatment Options
Treatment options for urethral strictures include:
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Dilation
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a balloon catheter is inflated or series of dilators are inserted into the urethra to gradually stretch (dilate) the strictured area in the urethra
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Obturation
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a thin, flexible, plastic tube (catheter) is inserted into the urethra on a regular basis to keep the stricture open
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Urethrotomy (endoscopic or optical internal urethrotomy)
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a minimally invasive procedure where an incision is made in the scar tissue in the urethra to open the stricture
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this is done through a fiberoptic cystoscope (endoscope) placed in the urethra with anesthesia
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Urethroplasty or open urethral reconstruction
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Anastomotic urethroplasty (primary anastomotic urethroplasty)
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the narrowed section of the urethra is surgically removed and the urethra is repaired
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Substitution urethroplasty
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the narrowed section of the urethra is surgically opened and/or removed and the urethra is repaired with a tissue graft or flap
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buccal mucosa graft (BMG)
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genital or other full-thickness skin grafts
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vascularized genital skin flaps
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One, two or multiple-staged reconstructive urethroplasty procedures
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Perineal urethrostomy
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a surgical procedure that creates a permanent and wider opening in the urethra in the perineum (the area between the anus and the scrotum)
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Long-term Follow-up
After the urethral stricture has been treated, frequent follow-up exams will be needed during the first year and then periodically thereafter to ensure that the stricture does not recur.
UMHS Department of Urology, November 2008
