Urethral Stricture refers to any narrowing of the urethra for any reason whether or not it actually impacts the flow of urine out of the bladder. Any inflammation of urethra can result in scarring, which then can lead to a stricture or a narrowing of the urethra. Trauma, infection, tumors, surgeries, or any other cause of scarring may lead to urethral narrowing or stricture. Mechanical narrowing of the urethra without scar formation (developmental causes or prostate enlargement) can also cause urethral stricture. Urethral stricture is significantly more common in men and boys compared to women and girls. This condition is considered rare in females.
Causes of Urethral Stricture
- Trauma from injury or accidents with damage to the urethra or bladder (for example, falling on a frame of a bicycle between the legs, or a car accident)
- Pelvic injury or trauma
- Previous procedures involving the urethra (urinary catheters, surgeries, cystoscopy)
- Previous prostate surgery (TURP or transurethral resection of the prostate)
- Prostate enlargement
- Cancer of the urethra (rare)
- Infections of the urethra (sexually transmitted diseases or STDs, urethritis, gonorrhea, chlamydia)
- Prostate infection or inflammation (prostatitis)
- Previous hypospadias surgery (a congenital birth defect in which the opening of the urethra is on the underside of the penis instead of the tip)
- Congenital malformations of the urethra, which rarely can cause urethral stricture in children
Signs and symptoms of Urethral Stricture
- Difficulty starting urine flow
- Painful urination (dysuria)
- Urinary tract infection (UTI)
- Urinary retention
- Incomplete emptying of bladder
- Decreased urine stream
- Dribbling of urine
- Spraying or double streaming urine
- Blood in the urine (hematuria)
- Blood in the semen
- Urinary incontinence
- Pelvic pain
- Discharge from the urethra
Investigation for Stricture Urethra
- Cystoscopy: Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The cystoscope is inserted into your urethra and slowly advanced into the bladder.
- Urethrography: A retrograde urethrogram is a routine radiologic procedure used to image the integrity of the urethra. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture.
- Uroflowmetry: Uroflowmetry is a diagnostic test that is administered to check for abnormalities in the amount or flow rate of a patient’s urine. The procedure is straightforward and painless, and simply involves urinating into a funnel device attached to an electronic meter.
Treatment of Stricture Urethra
- Urethral dilation.
- Internal and Laser Urethrostomy.
- Holmium laser urethrotomy.
- MCU- Micturiting Cystourethrogram