What is a Urethral Stricture?
The urethra is the tube through which urine is expelled from the bladder. A urethral stricture is a narrowing of the urethra due to scar tissue, which can block the flow of urine.
Urethral strictures are more common in men because their urethras are longer than those in women. Thus men's urethras are more susceptible to disease or injury. A person is rarely born with urethral strictures and women rarely develop urethral strictures.
What causes a Urethral Stricture?
- In most cases there is no identifiable cause for the stricture.
- Urethral trauma. A pelvic fracture or straddle injury can injure the urethra. Occasionally the urethra can be injured during passage of a catheter or instrument up the urethra during telescopic surgical procedures on the urethra, prostate or bladder.
- Urethritis - infection with gonorrhoea or chlamydia.
What are the symptoms of a Urethral Stricture?
Some symptoms that may be an indication of urethral strictures can include:
- Painful urination.
- Slow urine stream.
- Decreased urine output.
- Spraying of the urine stream.
- Blood in the urine.
- Abdominal pain.
- Urethral discharge.
- Urinary tract infections in men.
How are Urethral Strictures diagnosed?
- Urethrogram – an x-ray test where dye is injected up the urethra thorough a catheter placed just inside the opening of the urethra. Pictures are taken during the injection process (retrograde study) and during urination (antegrade study).
- Urethroscopy - telescopic examination.
What are the treatment options?
Treatment options for urethral stricture disease are varied and selection depends upon the length, location and degree of scar tissue associated with the stricture. Options include enlarging the stricture by gradual stretching (dilation), cutting the stricture with a laser or knife passed a through a scope (urethrotomy) and surgical removal (excision) of the stricture with reconnection and reconstruction possibly with grafts (urethroplasty).
Strictures have a tendency to recur. The time to recurrence may vary from a few weeks to several years. The only procedure, which has the potential to “cure” a stricture, is urethroplasty (see below).
The stricture is gradually stretched by passing progressively wider dilators (“sounds”) across the stricture. Strictures can also be dilated using a special balloon on a catheter. Dilation is rarely a cure and needs to be periodically repeated. If the stricture recurs too rapidly the patient may be taught how to insert a catheter into the urethra periodically to prevent early closure.
This procedure involves passing a special telescope (cystoscope) up the urethra and incising the stricture with a small blade or laser fibre passed through the cystoscope. A catheter is often placed for a few days whist the urethra is healing. Urethrotomy is often not curative and the stricture can recur. If the stricture recurs too rapidly the patient may be taught how to insert a catheter into the urethra periodically to prevent early closure.
This procedure involves placing a metal tube (stent) across the stricture. The Urethral stent is deployed through a special cystoscope after the stricture has been dilated or incised. The stent expands and holds the stricture open. Stents are not suitable for everyone. Problems with stents include: pain/discomfort; blockage from ingrowth of tissue or formation of stones; sometimes stents can be difficult to remove or replace if there are problems.
Open surgical urethral reconstruction (Urethroplasty)
If the stricture is short it may be possible to excise the scarred portion of the urethra and rejoin the ends of the normal urethra (anastomotic urethroplasty). This procedure has the highest rate of success.
Where the stricture is long (>2cm), or in an area where it is difficult to excise the abnormal scared portion, tissue may need to be moved from a nearby area (tissue flap) or from a distant part of the body (graft) to bridge any defect between the normal ends of the urethra (substitution urethroplasty). This procedure is associated with a higher rate of recurrent stricture compared to an anastomotic urethroplasty.
After treatment of stricture, patients need to be followed up by a urologist, due to the risk of recurrence.