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Urethral Stricture

The main function of urethra is to carry the urine from the bladder and out of the body inside the penis. The urethra is wide and allows a free flow of urine during urination. However, at times, the urethra narrows down which obstructs the flow of the urine. This condition is medically quoted as urethral stricture. The condition is reported to affect men primarily.

Causes, Incidence & Risk Factors

In the case of urethral stricture, the urethra is constricted. The primary reason for this condition is either swelling of the tissues or the presence of any scar tissue. The condition can also arise due to inflammation or tissue damage from surgery, disease, or injury. Moreover, in certain cases, the presence of an external tumor and the pressure exerted by it on the urethra or near it can also be a cause. However, this reason is rarely reported.

In the case of young boys, if hypospadias surgery is performed to treat underdeveloped urethra or in men, any treatment for penile implants are done, the chances of developing urethral stricture is higher.

Some of the common causes of urethral stricture include:

  • Pelvic fractures.
  • Catheter insertion.
  • Radiation.
  • Surgery performed on the prostate.
  • Benign prostatic hyperplasia.

Causes of Urethral Stricture

  • Tumor near the urethra.
  • Unattended or repeated urinary tract infections.
  • Sexually transmitted infections (STIs) gonorrhea or chlamydia.

Risk Factors of Developing Urethral Stricture

The chances of developing urethral stricture are higher in some men than in others. This is true in case the men have:

  • In case of one or more STIs history.
  • Catheter placement.
  • History of urethritis.
  • Enlarged prostate.

Signs & Symptoms

There is a range of signs and symptoms associated with urethral stricture. These symptoms are of all types, from mild to severe. Some of the common signs and symptoms of urethral stricture include:

  • Slow and weak flow of urine.
  • Reduced volume of urine.
  • Feeling of a full bladder, even after urination.
  • Urinary stream that frequently starts and stops.
  • Inability to hold the urine, also known as incontinence.
  • Dysuria (painful urination).
  • Difficulty urinating.
  • Urethral discharge.
  • Dark coloured urine.
  • Spraying of the urine stream.
  • Increased urinary frequency or urgency.
  • Lower abdominal pain.
  • Any swelling reported on the penis, testes, and scrotum.
  • Reoccurring urinary tract infections.

Diagnosis

There is a range of approaches used to diagnose the condition and the doctor would best suggest which approach should be used. The doctors start by reviewing the symptoms of the conditions in an individual. Then, they perform a physical exam of the penis and the surrounding area to identify any presence of urethral stricture. Finally, a range of tests is performed to confirm the presence of urethral stricture. The doctors might recommend one or a combination of the tests mentioned below:

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

Treatment

There are two main types of treatments for urethral stricture: non-surgical and surgical.

  • Non-surgical: In this case, the doctors widen the urethra with the help of a medical instrument known as a dilator. The procedure does not take long and the patient can move out of the hospital the same day. The process of dilation involves inserting a small wire into the bladder through the urethra. This dilates the entire passage, making way for urine to pass freely. However, in the case of acute urethral stricture, the doctors will place a suprapubic catheter to automatically drain out the urine. This is important in preventing urinary infections and urinary retention.
  • Surgical procedures: Urethroplasty is the most common type of surgical treatment for Urethral Stricture. It is recommended in case the stricture is large and more than one stricture is present in the passage. The doctors surgically remove the malign tissues and then repair the urethra. In case of severe urethral stricture, the doctors may perform surgery to change the flow of the urine inside the body. Post-treatment, the patient has the urine flowing through the abdomen, and parts of the intestines are used to connect it with the urethra. The treatment is known as Appendicovesicostomy (Mitrofanoff procedure). There are fairly no possible drug treatments for urethral stricture. The results of the recommended treatment depend upon various characteristics of the stricture such as length, degree of fibers, associated infection, previous surgeries.

Complications

One of the major outcomes of urethral stricture is urine retention which must be treated as soon as possible. Some other outcomes due to the medical condition include bladder stones, infections of the genitourinary tract, rarely malignancies.

Preventions

Safe sex is one of the best ways to reduce the risk of developing sexually transmitted diseases and thus urethral stricture. When attended in an early stage, the condition can be avoided from elevating.


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