What Is Urethral Stricture?
Urethral stricture is a medical condition that mainly affects men. According to the National Institutes of Health (NIH), very few women get urethral strictures. In addition, very few individuals are born with this condition (NIH).
Urethral stricture occurs specifically in the urethra. The urethra is a tube that carries urine from the bladder so it can be expelled from the body.
In healthy males, the urethra is wide enough for urine to flow freely through it. When the urethra narrows, it is known as a urethral stricture. Urinary flow can be slightly or severely restricted.
Causes of Urethral Stricture
Urethral stricture involves constriction of the urethra, which is usually caused by inflammation or the presence of scar tissue. Scar tissue can be a result of many factors. Young boys who have hypospadias surgery (a procedure to correct an underdeveloped urethra) and men who have penile implants have higher chances of urethral stricture.
According to the Center for Reconstructive Urology, a straddle injury is a common type of trauma that can lead to urethral stricture. Examples of straddle injuries include falling on a bicycle bar or getting hit in the area close to the scrotum.
Other specific causes include pelvic fractures, catheter insertion, radiation, and surgery performed on the prostate (Center for Reconstructive Urology).
Potential, but rare, causes include a tumor located in close proximity to the urethra, untreated urinary tract infections, and the sexually transmitted infection gonorrhea.
Risk Factors of Urethral Stricture
Certain segments of the male population have an elevated risk of developing urethral stricture. These include men who:
- have had one or more STIs
- have used a catheter (a small, flexible tube that is inserted into the body to drain urine from the bladder)
- have suffered from urethritis (swelling and irritation in the urethra)
- have an enlarged prostate
What Are the Main Symptoms of Urethral Stricture?
Urethral stricture can cause numerous symptoms, which range from mild to severe. Some of the signs of a urethral stricture include:
- weak urine flow or reduction in the volume of urine
- sudden, frequent urges to urinate
- pain during urination
- inability to control urination (incontinence)
- pain in the pelvic or lower abdominal area
- urethral discharge
- penile swelling
- presence of blood in the semen and/or urine
- darkening of the urine
- inability to urinate (very serious)
How Is Urethral Stricture Diagnosed?
To diagnose urethral stricture, doctors may use one or all of the approaches described below.
Reviewing Your Symptoms and Medical History
You can self-report the symptoms mentioned above. Your doctor may also ask about past illnesses and medical procedures to determine whether one or more risk factors are present.
Performing a Physical Examination
A simple physical examination of the penis area can help the doctor identify issues that indicate the presence of a urinary stricture. For instance, the doctor will be able to readily observe redness and find out if one or more areas are hard or swollen.
To make a definite diagnosis of a urethral stricture, the doctor may also decide to perform one or more of the following tests:
- measuring the rate of flow during urination
- analyzing the physical and chemical properties of urine to determine if bacteria are present
- cystoscopy–inserting a small tube with a camera on the end into the body to view the inside of the bladder and urethra
- measuring the size of the urethral opening
- tests for chlamydia and gonorrhea
Treatment Methods for Urethral Stricture | Treatment
The primary mode of treatment is to make the urethra wider using a medical instrument called a dilator. In this outpatient procedure, a doctor will begin by passing a small wire through the urethra and into the bladder. Over time, larger dilators will be used to gradually increase the width of the urethra. Another nonsurgical option is permanent catheter placement, however this is reserved for severe cases and carries risks such as bladder irritation and urinary tract infections.
Surgery is another option. An open urethroplasty may be performed for longer, more severe strictures. This procedure involves removing affected tissue, followed by reconstruction of the urethra. Results vary based on the stricture size.
Urine Flow Diversion
If the above approaches do not work, urine flow may need to be diverted and drained through a catheter in the abdomen. This is very rare, and considered a last-resort method.
Long-Term Outlook for Patients with Urethral Stricture
Many patients have a good outcome when they are treated for a urethral stricture. According to the National Institutes of Health, if the stricture is caused by scar tissue, future treatment may be necessary. (NIH)
In some cases, stricture can cause urinary retention (inability to urinate due to blockage in the urethra), a potentially dangerous condition. If you experience symptoms of stricture and become unable to urinate, seek medical attention immediately.
Is Urethral Stricture Preventable?
Urethral stricture is not a completely preventable condition. Since sexually transmitted infections are one cause, using protection during sexual contact can prevent some cases. However, injuries and other medical conditions associated with urethral stricture cannot always be avoided.
It’s important to see a doctor right away if you are experiencing symptoms of urethral stricture. Treating the problem quickly is the best way to avoid serious complications.