Posterior Urethral Stenosis

What is posterior urethral stenosis?

Posterior urethral stenosis (PUS) is a type of urethral stenosis (sometimes called urethral stricture) that causes your posterior urethra — the area of your urethra closest to your urinary bladder — to narrow. Severe posterior urethral stenosis may cause your urethra to get so narrow that it’s difficult or even impossible to urinate (pee).

People assigned male at birth (AMAB) are more likely to have posterior urethral stenosis than people assigned female at birth (AFAB). That’s because the urethra in people AMAB is much longer — typically 8 to 9 inches long (about 20 centimeters), whereas in people AFAB, the urethra is about 1.5 inches (3 to 4 centimeters) long. The uppermost 1 to 2 inches of the urethra in people AMAB is the posterior urethra. It includes the opening of the bladder (bladder neck), the external urethral sphincter muscle and the section of the urethra that passes through the prostate.

How common is posterior urethral stenosis?

Posterior urethral stenosis isn’t common. It usually develops after treatment on another condition in the area. In rare cases, it’s present at birth (congenital).

Posterior urethral stenosis is rare in people AFAB.

What are the symptoms of posterior urethral stenosis?

Symptoms of posterior urethral stenosis may include:

• Trouble peeing, including a weak stream, peeing less than normal or not feeling like you completely emptied your bladder (urinary retention).
• Pain while peeing (dysuria).
• Urinary tract infection (UTI).
• Prostate infection.
• Dark pee or blood in your pee (hematuria).
• Abdominal pain.

What causes posterior urethral stenosis?

In some rare cases, posterior urethral stenosis is congenital. But it usually occurs as a result of an injury or a medical examination or treatment in the area. Examples include:

• A pelvic fracture that damages your urethra.
• Prostate cancer treatments, including radiation therapy, seed implants (brachytherapy), external beam radiation therapy (EBRT) and prostate removal surgery (prostatectomy).
• Benign prostatic hyperplasia (BPH) surgery, including transurethral resection of the prostate (TURP).

Does posterior urethral stenosis get worse over time?

Without treatment, posterior urethral stenosis may get worse over time and cause:

• Regular UTIs.
• Permanent bladder damage.
• Pee to back up into your kidneys from your bladder (vesicoureteral reflux).
• Kidney damage.

Who does posterior urethral stenosis affect?

People AMAB who have an injury in the area or who require treatment for prostate cancer or BPH are more likely to have posterior urethral stenosis.

How is posterior urethral stenosis diagnosed?

A healthcare provider will review your medical history, ask about your symptoms and conduct a physical exam. They may also order tests to help them make an official diagnosis, including:

• X-rays.
• Ultrasound.
• Cystoscopy.
• Retrograde urethrogram.
• Voiding cystourethrogram (VCUG).

Is posterior urethral stenosis curable?

Yes, treatment is available to correct posterior urethral stenosis.

How do you fix posterior urethral stenosis?

Posterior urethral stenosis treatment depends on its cause, how much scar tissue exists and the length of the stenosis. There aren’t any medications available that can treat this condition. Treatment options typically include:

• Urethral dilation. This is a minimally invasive procedure that uses long, thin rods or a balloon to widen (dilate) the stenosis. Urethral dilation isn’t permanent. You may need multiple procedures.
• Urethroplasty. This is a surgery that repairs or replaces the affected area of your posterior urethra. It has a much higher success rate than urethral dilation.

What are the complications/side effects of posterior urethral stenosis?

Posterior urethral stenosis can occur again after treatment. You should schedule regular follow-up appointments with a healthcare provider to make sure you’re healing correctly and that the condition doesn’t come back. You may need several tests to monitor the condition. If scarring develops again, you may need to repeat treatment. You’re more likely to need multiple urethral dilation procedures. The success rate of urethroplasty is over 80%.

How soon after treatment will I feel better?

Most people typically feel better within a week after urethral dilation. It may take up to two or three weeks to completely recover after urethroplasty.

Can posterior urethral stenosis be prevented?

You can’t prevent every cause of posterior urethral stenosis. But one way to prevent it is to avoid injury to your pelvis — specifically, a pelvic fracture. You can help prevent pelvic injuries by:

• Always wearing a seatbelt while riding in an automobile.
• Wearing proper padding or equipment during high-impact sports (for example, hockey, football, martial arts and lacrosse).
• Following eating patterns that promote bone health with nutrients like calcium and vitamin D.
• Asking a healthcare provider about bisphosphonates to help slow down bone loss.
• Doing exercises that help strengthen your bones, especially weight-bearing activities.
• Quitting smoking and limiting your alcohol intake. Smoking and excessive alcohol consumption can affect your bone density.

What can I expect if I have posterior urethral stenosis?

The outlook for posterior urethral stenosis is generally good. Treatment can dilate, repair or remove the affected area of your urethra. But posterior urethral stenosis can return, which may require multiple procedures. You must schedule regular follow-up appointments with a healthcare provider to make sure it doesn’t come back.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider if you notice any symptoms of PUS, including changes to your ability to pee or how your pee looks.

When should I go to the ER?

Go to the nearest emergency room if you have any of the following symptoms:

• Inability to pee.
• Increased pain while peeing.
• Blood in your pee.
• Signs of an infection.

What questions should I ask a healthcare provider?

You may want to ask your provider:

• How do you know that I have a posterior urethral stricture?
• What caused the posterior urethral stricture?
• How big is my posterior urethral stricture?
• How should I take care of myself?
• What treatment do you recommend?
• What are the risks and benefits of each treatment option?
• How often should I schedule follow-up appointments?
• Do you think my posterior urethral stricture will come back?
• Is there anything I can do to stop the posterior urethral stricture from coming back?
• Can you recommend a urologist?

What is the difference between a urethral stricture and stenosis?

“Stricture” and “stenosis” are both terms that healthcare providers use to describe how a passage or opening narrows. A urethral stricture affects the part of your urethra that passes through your corpus spongiosum. The corpus spongiosum is a tubelike chamber that runs along the bottom of your penis. Stenosis affects the part of your urethra that passes through your prostate or bladder neck.

A note from Cleveland Clinic

Posterior urethral stenosis is an uncommon condition that can affect anyone. But it typically affects people assigned male at birth. It occurs when scar tissue develops in the uppermost 1 to 2 inches of your urethra. It can cause uncomfortable or embarrassing problems that affect how you pee. But you don’t have to live with these problems. Posterior urethral stenosis is treatable, and the success rate is good. Talk to a healthcare provider if you have symptoms, especially after an injury to your pelvis or treatment in the surrounding area.