Urethral Stricture in Men
What is a urethral stricture?
Urethral stricture is a narrowing of the urethra. Your urethra is the tube that carries urine from the bladder through the penis and out the urethral meatus (the opening at the tip of the penis) during urination.
Many men with a stricture will have increasing discomfort with urinating and a slowing of the urinary stream. This can develop gradually and lead to pushing or straining to get urine out. In others, the problem will show up suddenly and without prior difficulty, requiring immediate care.
Symptoms and Causes
What causes urethral stricture?
The most common causes appear to be chronic inflammation or injury. Scar tissue can gradually form from:
- An injury to your penis or scrotum or a straddle injury to the scrotum or perineum.
- An infection, most often sexually transmitted diseases like chlamydia.
- Placement of catheters or instruments into the urethra during surgery or procedures.
The scar tissue causes the urethra to become narrow, making it more difficult for urine to flow. Sometimes, the inflammation or injury to the urethra happens long before the stricture becomes noticeable. In other cases, the stricture happens soon after a urethral injury.
What are the symptoms of urethral stricture?
The most obvious sign of urethral stricture is a weakened urinary system. Symptoms of this can include:
- Straining to urinate.
- Pain during urination.
- Urinary tract infection.
Some patients with severe urethral strictures are completely unable to urinate. This is referred to as urinary retention, and is a medical emergency. Hydronephrosis and renal failure may also happen from backup of urine into the kidneys from a poorly draining bladder.
A urethral stricture can also cause inflammation of the prostate. Your urethra is surrounded by the prostate, just under the bladder. This inflammation of the prostate is known as prostatitis. Urinary backup can also cause complicated urinary tract infections. These can be managed with antibiotics and treatment of the urethral stricture.
Diagnosis and Tests
How is urethral stricture diagnosed?
Non-invasive testing may identify issues emptying the bladder, but cannot definitively identify a stricture. The rate at which your urine flows can be measured by urinating into a collection device – slow flow on this test could be caused by blockage of the urethra or a weak bladder. The post-void residual volume (the amount of urine left in the bladder when you are done urinating) can be measured by doing an ultrasound scan of the bladder. Normally, the bladder is empty after urinating, but with a stricture, some urine may stay in the bladder. From non-invasive testing it isn’t possible to determine if these issues could be due to a stricture, enlarged prostate, weakened bladder or other problem.
If a urethral stricture is suspected, an imaging procedure will be needed to identify and measure it. One procedure is a retrograde urethrogram. This is an X-ray procedure that uses a contrast agent that is squirted into the opening of the penis. The contrast shows up on an X-ray film to locate the stricture and its length. Sometimes, you will be asked to urinate once the bladder is full so that the stricture can be recognized during the voiding process.
Cystoscopy is a procedure in which a small, flexible, camera called a cystoscope is inserted into the penis. This procedure allows your doctor to see inside the urethra. It is done in the doctor’s office and it typically takes five to 10 minutes. Before the procedure, lidocaine jelly (a numbing medication) will be inserted into your urethra, allowing the doctor to pass the cystoscope into your bladder with less discomfort.
Management and Treatment
How is urethral stricture treated?
The treatment for urethral stricture will be decided by the findings on the imaging procedures. Treatment options include:
- Urethral dilation.
- Internal urethrotomy.
- Urethral reconstruction.
With a short stricture, urethral dilatation or internal urethrotomy may be tried first. Under general anesthesia, the urethra is widened using a series of gradually larger dilating instruments and a cystoscope. A urethrotomy is when the cystoscope is used with a special tool to cut the ring of scar tissue and open the area of blockage.
After the procedure, a urethral catheter is usually left in the urethra for three to five days. The most common problem of dilation or urethrotomy is the return of the stricture, but in some cases this procedure may correct the issue. You can expect blood in the urine for a period of time after this or any procedure on the urinary tract.
If dilation or urethrotomy fails and the stricture returns, urethral reconstruction may be needed to obtain a durable result in terms of opening the urethra. In some cases, the urethra is reconstructed by removing the scar tissue and then suturing the ends of the urethra back together, called an urethroplasty. When this is not possible, the urethra may be rebuilt using the lining of the inside of the cheek or skin flaps from the penis or scrotum. This procedure is a different type of urethroplasty. Using these methods, the urethra can be reconstructed in most cases with a good long-term success rates.
How do I prevent urethral stricture?
By avoiding injury to the pelvic area of the body, it may be possible to prevent some forms of urethral stricture. Taking care to avoid infection may also help prevent this condition.
Outlook / Prognosis
What is the outlook for urethral stricture?
Urethral stricture has a generally positive outcome. It is a treatable condition. However, this condition can happen again, requiring multiple procedures. Follow-up appointments with your healthcare professional will be needed after being treated for urethral stricture.