The urethra is a tube that carries urine from the bladder so it can be expelled from the body. Usually the urethra is wide enough for urine to flow freely through it. When the urethra narrows, it can restrict urinary flow. This is known as a urethral stricture. Urethral stricture is a medical condition that mainly affects men.
Causes
Urethral stricture involves constriction of the urethra. This is usually due to tissue 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 a higher chance of developing urethral stricture. 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. Men are more likely to have a urethral disease or injury because of their longer urethra. For this reason, strictures are more common in men. They are rare in women and in infants. Stricture (narrowing of the urethra) can happen at any point from the bladder to the tip of the penis. This narrowing restricts or slows the flow of urine in. Some common causes are:
- trauma to the urethra
- infection such as a sexually transmitted disease
- damage from surgical tools
- conditions that cause swelling
In most cases, no cause can be found.
In adults, urethral strictures are most often due to:
- injury from a fall onto the scrotum or perineum
- prostate surgery
- kidney stone removal
- urinary catheterization
- other surgical tools
Risk Factors
Some men have an elevated risk of developing urethral stricture, especially those who have:
- had one or more STIs
- had a recent catheter (a small, flexible tube inserted into the body to drain urine from the bladder) placement
- had urethritis (swelling and irritation in the urethra), possibly due to infection
- an enlarged prostate
Symptoms
Urethral stricture can cause numerous symptoms, ranging 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
- a feeling of incomplete bladder emptying after urination
- frequent starting and stopping urinary stream
- pain or burning during urination
- inability to control urination (incontinence)
- pain in the pelvic or lower abdominal area
- urethral discharge
- penile swelling and pain
- presence of blood in the semen or urine
- darkening of the urine
- inability to urinate (this is very serious and requires immediate medical attention)
Diagnosis
Doctors may use several approaches to diagnose urethral stricture.
- 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 the presence of a urinary stricture. For instance, the doctor will be able to readily observe redness (or urethral discharge) and find out if one or more areas are hard or swollen. - Conducting tests
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 (or blood) are present
- cystoscopy: inserting a small tube with a camera into the body to view the inside of the bladder and urethra (the most direct way to check for stricture)
- measuring the size of the urethral opening tests for chlamydia and gonorrhea
Treatment
There are many options depending on the size of the blockage and how much scar tissue is involved. Treatments include:
- dilation – enlarging the stricture with gradual stretching
- urethrotomy – cutting the stricture with a laser or knife through a scope
- open surgery – surgical removal of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty)
There are no available drugs to help treat strictures. Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can’t pass urine), which could lead to an enlarged bladder and kidney problems.
Prevention
- Avoid injury to the urethra and pelvis.
- Be careful with self-catheterization
- Use lubricating jelly liberally
- Use the smallest possible catheter needed for the shortest time
- Avoid sexually transmitted infections.
- Gonorrhea was once the most common cause of strictures.
- Antibiotics have helped to prevent this.
- Chlamydia is now the more common cause.
- Infection can be prevented with condom use, or by avoiding sex with infected partners.
- If a problem occurs, take the right antibiotics early. Urethral strictures are not contagious, but sexually transmitted infections are.
