Urethral Stricture

The urethra is the tube that carries urine out of the body. The tube becomes narrow due to a scar, swelling, injury, or infection and causes difficulty and discomfort while urinating. This condition is called urethral stricture.

The most common sign is a weakened urinary system. Symptoms that include are:

• Straining to urinate
• Pain during urination
• Urinary tract infection
• Prostatitis
• Blood in semen
• Abdominal pain
• Loss of bladder control
• Swelling in penis
• UTIs in men

Some people having severe urethral stricture conditions cannot urinate. This is a medical emergency. Hydronephrosis and renal failure may also occur from the backup of urine into the kidneys from a poor draining bladder.

This problem occurs mostly in men because of their longer urethra. This condition is rare in women and infants. Stricture may happen at any point from the bladder to the tip of the penis. A few common causes are trauma to the urethra, infection, damage because of surgical tools, injury, prostate surgery, kidney stone removal. In many cases, no cause can be found.

Posterior Urethral Stricture

Strictures that happen in the first 1" to 2" of the urethra where urine passes through are called posterior strictures. This type of stricture is due to an injury along with a pelvic fracture. In such cases, the urethra is disrupted and separated. Urine cannot pass, a catheter is placed in the bladder either through the abdomen or penis. This helps the urine drain until the stricture is fixed.

Anterior Urethral Stricture

Strictures that happen in the last 9" to 10" of the urethra are called anterior strictures. These are caused by trauma from a straddle injury, direct trauma to the penis, catheterization.

There are no medications to help treat strictures. Without proper treatment, problems will persist. Urinary infections and stones may develop. Urinary retention is very high which can lead to an enlarged bladder and kidney problems.

There are different tests to diagnose urethral stricture- physical exam, urethral imaging such as X-ray or ultrasound, urethroscopy, retrograde urethrogram.

Depending on the size of the blockage and scar tissue there are many options available

Dilation- this treatment involves inserting special devices to enlarge the stricture with gradual stretching.

Urethrotomy- done by cutting the stricture with a laser or knife through a scope and open the blockage.

Open Surgical removal- when dilation and urethrotomy fail and the stricture returns then surgical removal of the stricture with reconnection and reconstruction, urethroplasty is done.

Anastomotic Urethroplasty- this is done for short urethral strictures. In this, a cut is made between the scrotum and rectum. A small catheter is placed in the penis for 10 -21 days and removed after an X-ray is taken to ensure the repair is healed.

Substitution Urethroplasty- this is performed when the stricture is long, tissue can be transferred to replace the section that had the stricture. In complex cases, substitution repairs are done in stages. The three types of substitution procedures are free graft, skin flap, and staged.