Posterior Urethral Stenosis

Overview

What is posterior urethral stenosis?

Urethral stenosis (sometimes called urethral stricture) is a narrowing of the urethra. A part of your urinary system, the urethra is the tube that urine passes through to leave the body when you urinate. For men, the uppermost one to two inches of the urethra is the posterior urethra. This includes the opening of the bladder and the part of the urethra that’s surrounded by the prostate and the external urethral sphincter muscle. When you have severe stenosis, it might restrict your ability to pass urine. Males are more likely to have posterior urethral stenosis than females.

Symptoms and Causes

What causes posterior urethral stenosis?

You can actually be born with posterior urethral stenosis. However, this is rare. More commonly, urethral stenosis is secondary to another medical condition or treatment. A pelvic fracture can result in posterior urethral stenosis due to an associated urethral injury. This condition can also happen as a result of prior treatments for prostate cancer. Prostate cancer treatments that could cause urethral stenosis can include radiation therapy, seed implants or surgery.

Surgery for benign prostate enlargement, or instrumentation for other urological conditions can also be causes of posterior urethral stenosis.

What are some of the symptoms of posterior urethral stenosis?

If you have posterior urethral stenosis, there are several symptoms you might experience, including:

Diagnosis and Tests

How is posterior urethral stenosis diagnosed?

There are several tests your healthcare provider may do to diagnose posterior urethral stensosis. These tests might include:

  • A physical exam.
  • X-rays.
  • Ultrasound.
  • Urethroscopy.
  • Retrograde urethrogram and voiding cystourethrogram.

Urethroscopy involves the placement of a bendable scope into your urethra and then moving it to the area of the stenosis. Retrograde urethrogram is a test to help determine the position and length of the stenosis using X-rays with contrast dye. If there’s a suprapubic catheter in place, your provider might also do a voiding cystourethrogram.

Management and Treatment

What is the treatment for posterior urethral stenosis?

The way your healthcare provider will treat posterior urethral stenosis will be based on the cause of the problem, how much scar tissue you have and the length of the stenosis. There aren’t any medications available to treat this condition. Your treatment options typically include:

  • Dilating the stenosis.
  • Open surgery (urethroplasty).
  • Urethrotomy.

If you have open surgery, the affected area of scar tissue can be removed and the healthy ends of the urethra are then stitched (sutured) together. Urethrotomy involves the use of a scope to cut the stenosis to enlarge the channel with the hope that it will then heal in a more open way.

What care is needed after treatment for posterior urethral stenosis?

Urethral stenosis can happen again after treatment. You’ll need to have regular follow-up appointments with your healthcare provider to make sure you’re healing correctly and to make sure the condition hasn’t returned. You may need several tests, including appropriate exams and X-rays. If obstruction reoccurs, the procedure might need to be repeated.

Prevention

How can posterior urethral stenosis be prevented?

The main way you can prevent posterior urethral stenosis is to avoid injury — specifically pelvic fracture. One way to do this is to always wear a seat belt and follow best practices to stay safe at work. Also, it’s wise to have regular follow-up appointments after treatment for prostate cancer. These follow-up appointments can help your healthcare provider identify any issues quickly and manage the condition right away.

A note from Cleveland Clinic

It can be difficult sometimes to talk about issues related to urination. However, if you’re experiencing any of the symptoms of urethral stenosis, you should reach out to your healthcare provider. This condition can be treated, helping relieve your symptoms.

Last reviewed by a Cleveland Clinic medical professional on 02/26/2021.

References

  • Mundy AR. Management of urethral strictures. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585709/) Postgraduate Medical Journal. 2006 Aug;82(970):489-493. Accessed 3/25/2021.
  • Urology Care Foundation. What is Urethral Stricture Disease? (http://www.urologyhealth.org/urologic-conditions/urethral-stricture-disease/causes) Accessed 3/25/2021.
  • American Urological Association. Male Urethral Stricture. (http://www.auanet.org/guidelines/male-urethral-stricture-(2016%29) Accessed 3/25/2021.

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