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Diseases & Conditions

Urethral Strictures & Urinary Fistulas

What is a urethral stricture?

A urethral stricture is a scar that develops in the urethra (the tube that runs from the bladder to the end of the penis, through which urine passes). The stricture narrows the urethra and can lead to problems with urination, including a complete inability to urinate.

What are the causes of a urethral stricture?

Most strictures come about because of an accident, such as a straddle injury. Other causes include:

  • having a urethral catheter in place
  • a fractured pelvis
  • a rash-like condition of the penis known as lichen sclerosus

Some men are born with a condition known as hypospadias, in which the urethra doesn’t develop properly. In babies born with hypospadias, the opening of the urethra forms in a location other than the tip of the penis. This location may be on the shaft of the penis or on the scrotum. Boys can have surgery to correct hypospadias, but may develop urethral strictures later in life.

What are the symptoms of a urethral stricture?

If a man has a urethral stricture, he may have some of the following symptoms:

  • Swelling in the penis
  • Dark or bloody urine
  • Frequent urination or a strong urge to urinate
  • Pain upon urinating
  • Lack of bladder control
  • Urethral discharge
  • Blood in the semen
  • Pain in the pelvic area

How is a urethral stricture diagnosed?

If the patient has any symptoms, a doctor will examine him and feel for lumps in the urethra. The doctor may insert a thin, lighted tube called a cystoscope into the penis in order to see the urethra. In addition, an x-ray of the urethra is often performed using contrast dye. The contrast allows the stricture to be seen more easily.

How is a urethral stricture treated?

In some cases, a urethral stricture can be treated by dilating (widening) the urethra. The doctor may also use a cystoscope to look inside the urethra and cut thought the stricture. One problem with these procedures is that a fairly high percentage of strictures recur (come back), and the patient may need more advanced surgery for a cure.

There are two main types of surgery (known as urethroplasty) to reconstruct the urethra. If the stricture is short enough, the surgeon may be able to remove the narrowed section of the urethra and then stitch the healthy ends of the urethra directly together.

If the stricture is too long for this type of surgery, then a procedure called “substitution urethroplasty” is necessary. During a substitution urethroplasty, the urethra is rebuilt over a longer distance. This is usually done by using buccal mucosa, the inner lining of the cheek, to replace the scarred tissue.

These procedures are successful up to 95% of the time. When the surgery is successful, the patient does not need to have future procedures. He also will not need to self-catheterize (insert a catheter into his penis in order to drain urine).

What is a rectourethral fistula?

A rectourethral fistula is an abnormal hole that forms between the urethra and the rectum. In patients who have a rectourethral fistula, problems can include passage of urine through the rectum, repeated infections, and swelling and discomfort in the pelvis.

What causes a rectourethral fistula?

Some patients who have surgery and/or radiation therapy for prostate or rectal cancer can develop a rectourethral fistula.

How is a rectourethral fistula treated?

A surgeon performs a urethroplasty (see above) to reconstruct the urethra. Surgery for a rectourethral fistula is usually done through the perineum (the area between the scrotum and the rectum). Surgery at this site brings about a quicker recovery than an operation through the abdomen. In this surgery, the rectum and urethra are carefully separated and the hole on each side closed. In complex cases, a muscle flap from the inner thigh is used to the fill the space in between and act as a barrier to prevent the fistula from occurring again.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/8/2016…#15182