Urethral stricture

Definition

Urethral stricture is an abnormal narrowing of the urethra (the tube that releases urine from the body).

Causes

Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.

Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis, or benign prostatic hyperplasia (BPH). There is also increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra (such as a catheter or cystoscope) increases the chance of developing urethral strictures.

Congenital (present at birth) pediatric strictures are rare, as are true strictures in women.

Symptoms

• Dysuria (painful urination)
• Difficulty urinating
• Slow urine stream (may develop suddenly or gradually)
• Spraying of urine stream
• Decreased urine output
• Increased urinary frequency or urgency
• Incontinence
• Blood in the semen
• Pelvic pain
• Lower abdominal pain
• Bloody or dark urine
• Discharge from the urethra
• Swelling of the penis
• Urinary retention

Exams and Tests

A physical examination may reveal the following:

• Decreased urinary stream
• Enlarged or tender lymph nodes in the inguinal (groin) areas
• Redness or swelling of the penis
• Urethral discharge
• Enlarged or tender prostate
• Distended bladder
• Hardness (induration) on the under surface of the penis

Sometimes the exam reveals no abnormalities.

Tests include the following:

• Urinary flow rate may be measured
• Post-void residual (PVR) measurement
• Urinalysis
• Urine culture (if evidence of infection)
• Tests for chlamydia and gonorrhea
• Cystoscopy to confirm diagnosis
• A retrograde urethrogram to confirm diagnosis

Treatment

Placement of a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary to alleviate acute problems such as urinary retention.

Dilation of the urethra may be attempted by inserting a thin instrument to stretch the urethra under local anesthesia. If urethral dilation is not possible, surgery may be necessary to correct the condition. Surgical options vary depending on the location and the length of the stricture.

Cystoscopic visual urethrotomy may be all that is needed for small stricture. A urethral stent may be inserted thru the cystoscope.

An open urethroplasty may be performed for longer stricture by removing the diseased portion or replacing it with other tissue. The results vary depending on the size and location of urethroplasty, the number of prior therapies, and the experience of the surgeon.

There are no drug treatments currently available for this disease. If all else fails, a urinary diversion -- appendicovesicostomy (Mitrofanoff procedure) -- may be performed to allow the patient to perform self-catheterization of the bladder through the abdominal wall.

Outlook (Prognosis)

Treatment usually results in an excellent outcome. However, repeated therapies may be needed to remove the scar tissue.

Possible Complications

Urethral stricture may totally block urine flow, causing acute urinary retention, a condition that must be alleviated quickly.

When to Contact a Medical Professional

Call your health care provider if symptoms of urethral stricture occur.

Prevention

Practicing safer-sex behaviors may decrease the risk of contracting sexually transmitted diseases and subsequent urethral stricture.

Early treatment of urethral stricture may prevent complications such as kidney or bladder infection or injury.