Urethral stricture is an abnormal narrowing of the urethra (the tube that releases urine from the body).

Causes, Incidence & Risk Factors

Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.

Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis, or benign prostatic hyperplasia (BPH). There is also increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra (such as a catheter or cystoscope) increases the chance of developing urethral strictures.

Congenital (present at birth) pediatric strictures are rare, as are true strictures in women.

Signs & Symptoms

  • Dysuria (painful urination).
  • Difficulty urinating.
  • Slow urine stream (may develop suddenly or gradually).
  • Spraying of urine stream.
  • Decreased urine output.
  • Increased urinary frequency or urgency.
  • Incontinence.
  • Lower abdominal pain.
  • Bloody or dark urine.
  • Discharge from the urethra.
  • Swelling of the penis, testes, scrotum.
  • Urinary retention.
  • Recurrent infections or urinary tract.

Diagnosis

  • Urinary flow rate.
  • Post-void residual (PVR) measurement.
  • Urinalysis.
  • Urine culture.
  • Tests for chlamydia and gonorrhea.
  • A retrograde urethrogram to confirm diagnosis.
  • Urethroscopy.

Treatment

Placement of a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary to alleviate acute problems such as urinary retention and infection. Surgical options vary depending on the location and length of the stricture. Visual internal urethrotomy may be all that is needed for small stricture. A urethral catheter is left in place after the procedure.

An open urethroplasty may be performed for longer stricture by removing the diseased portion or replacing it with other tissue. The results vary depending on the size and location of stricture, the number of prior therapies, and the experience of the surgeon. There are no drug treatments currently available for this disease. If all else fails, a urinary diversion – Appendicovesicostomy (Mitrofanoff procedure) – may be performed to allow the patient to perform self-catheterization of the bladder through the abdominal wall.

Results of treatment depend upon the characteristics of the stricture viz. its length, degree of fibres, associated infection, previous surgeries.

Complications

Urethral stricture may totally block urine flow, causing acute urinary retention, a condition that must be alleviated quickly. Bladder Stones, infections of gerito urinary tract, rarely malignancies.

Preventions

Practicing safer-sex behaviors may decrease the risk of contracting sexually transmitted diseases and subsequent urethral stricture. Early treatment of urethral stricture may prevent complications such as kidney or bladder infection or damage.

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