Urethral stricture, a narrowing of the urethra, is a fairly common urological condition which can have a significant impact on a sufferer’s life. Although patients may often dismiss the first symptoms as just a passing discomfort or prostate trouble, urethral stricture can lead to serious complications if it is not diagnosed and treated in a timely manner.  

 

What is urethral stricture?

The urethra is the tube that carries urine (pee) from the bladder outside the body. It is of greater length in the male, since it also passes through the prostate and penis. This is the reason why men are more likely to suffer injury and inflammation of the urethra than women. Scar tissue can sometimes form within the interior of your urethra and this may impede normal urine flow. Urethral stricture is simply the medical term for this narrowing.

The stricture can occur at any point in the urethra and with varying degrees of severity. In many cases, the narrowing is quite limited, and causes only mild symptoms. However, in more serious cases, the narrowing can significantly affect the normal functioning of the urinary system. 

 

What causes urethral stricture?

You may first start to be aware of any symptoms quite a long time after the actual event that triggered the formation of scar tissue, as they will often become noticeable only gradually over time.

There are various reasons why scar tissue can form in the urethra.

• A particularly common cause is damage to the urethra from injuries in the groin area, accidents, falls, or injuries to the perineum (area between the genital organs and the anus). All these can damage tissue and lead to scarring.
• Injures suffered during the placement of urinary catheters or surgical instruments in your urethra during surgery or other medical procedures, including prostate surgeries.
• Certain urinary infections or sexually transmitted infections (STI) may cause inflammation of the urethra wall, which can over time develop into scar tissue.

Very often it is not possible to identify a clear cause for the narrowing of the urethra – the medical term for cases where the cause remains unidentified is idiopathic urinary stricture.

 

What are the symptoms of urethral stricture?

As mentioned above, symptoms of urethral stricture tend to become only gradually noticeable. Often people get used to these changes in how they are passing urine and adapt to them, which may mean they delay seeking medical help.

The following symptoms may be observed:

• Poor urinary flow is the most common symptom. You may notice urine coming out with less force than in the past, or that it takes longer to finish passing urine.
• You may need to strain to begin passing urine. Or you may have the feeling after urinating that the bladder isn’t emptied all the way.
• Needing to pass urine more often than in the past (frequency).
• Some people experience spraying or splitting of the urinary stream, or dribbling of urine after urination.
• Repeated urinary tract infections.
• Pain on passing urine.
• Blood in the urine.
• In extreme cases, the narrowing of the urethra may lead to total inability to urinate (inability to pee), a situation which requires urgent medical intervention.

 

What complications can it lead to?

Untreated, urethral stricture may lead to serious problems in the urinary system. Chronic blockage of normal urine flow increases pressure inside the bladder. Over time the functioning of the bladder will be affected by this chronic strain.

In addition, the trapped urine tends to promote the development of urinary tract infections and bladder stones. In serious cases, the blockage can even affect kidney function, causing distension of the upper urinary tract.

This is why timely diagnosis is so important.

 

How is diagnosis made?

To make a diagnosis of urinary stricture, you will be asked about your symptoms and your medical history. During urological examination, the doctor assesses your urination pattern and looks for potential risk factors such as previous surgeries, injuries or infections.

Uroflowmetry is one of the basic tests. It measures the speed and force of urine flow and can reveal characteristic findings that suggest an obstruction. A urinary tract ultrasound helps assess the bladder and kidneys, while for many people radiographic contrast imaging methods (urethrography or cystourethrography) may be required to precisely locate the stricture.

Cystoscopy also has a vital role. During this procedure, the urologist directly examines the inside of the urethra using a special endoscopic instrument.

 

How is urinary stricture treated?

Treatment depends on the length, location, and severity of the stricture, as well as the patient’s medical history. In some mild cases, urethral dilation may be performed. This minimally invasive method can temporarily improve symptoms by stretching the narrowed section of the urethra using a balloon or gradually widening rods. However, patients can often find that the problem returns. 

Another option is endoscopic urethrotomy, in which cuts are made in the scar tissue of the stricture using a special endoscopic instrument. This method can provide an effective solution in certain cases. However, recurrent strictures often require a more permanently effective treatment.

 

Current open surgery techniques

Today, urethroplasty is considered the treatment of choice for many cases of urethral stricture, particularly when the stricture is extensive, or has come back after previous treatments.

Urethroplasty is reconstructive surgical procedure aimed at permanently repairing the urethra. Depending on the characteristics of the stricture, it may be performed by removing the affected segment, or by using grafts taken from the buccal mucosa (the inside of the cheek). Modern techniques have very high success rates and offer long-term effective results, significantly reducing the risk of the stricture coming back.

Urethral stricture is a condition that can significantly affect urination and quality of life, but using the latest diagnostic and reconstructive techniques, the treatment of urethral stricture is now more effective than ever and can allow patients to fully enjoy normal daily life once again.