Urethral stricture refers to a condition where the urethra (the tube connecting the bladder and the penis in men and to the urethral opening in women) narrows down restricting the free flow of urine causing symptoms and complications if left untreated.
Urethra in men is longer than urethra in women. That increases the odds of having an urethral stricture in males compared to having an urethral stricture in females. The narrowing of the urethra can be caused due to various reasons including trauma, infection or even stones in kidneys.
Anterior stricture – If the constriction of the urethra happens at 1 to 2 inches in the end (near the outlet), the condition is called anterior stricture.
Posterior stricture – If the constriction of the urethra happens at 1 to 2 inches in the beginning, where it connects to the bladder and extends through the prostate and sphincter muscles, the condition is called posterior stricture.
Urethral Stricture Causes
- Trauma or injury to the penis (in case of anterior stricture) or in the abdomen (posterior stricture). This can be due to fall or an accident.
- Infection from inside the body or through sexually transmitted infection
- Injury caused inside the abdomen during a surgery such as prostate surgery
- Surgical procedure where a catheter may have to be inserted.
- Procedures like kidney stones removal, performed through urethral opening.
Depending on the cause, that particular part of the urethra may get damaged leading to inflammation and/or stricture.
Urethral stricture symptoms
The primary symptom of urethral stricture is reduced flow of urine and leakage even after emptying the bladder.
- Reduced flow or spraying of urine
- Pain while urinating
- Other symptoms of UTIs (if the stricture is due to an STI or other infections)
- Blood or dark coloured urine (in extreme cases)
- Abdominal pain
- Swelling of penis
Improper emptying of the bladder for longer periods can lead to kidney damage.
Urethral stricture diagnosis & treatment
Treatment of urethral stricture starts with a few questions to understand what’s going on, followed by a physical examination by your doctor. The intention is to see if there is anything obvious that can indicate the location and possibility of the constriction.
An x-ray or ultrasound may be required to locate the stricture. In some cases, a cystoscope with a bulb and camera may be inserted into the urethra to view the interiors of the urethra. In very few cases, urethrogram may be required.
Urethrogram is a procedure where a dye is injected into the urethra through the penile or urethral opening (in case of women). The dye can also be injected into the urethra through the abdomen (from the other end of the urethra). This helps the gynaecologist image and analyse the exact location of the constriction when imaged with an x-ray.
In most cases, treatment of urethral stricture needs a surgical intervention that does either of the following:
- Remove the stricture or the blockage by scraping or cutting it off.
- Cut off the urethra where it is damaged and bridge the gap with grafting, skin flap etc.
Dilation of urethra is also an option where the urethra is stretched in step by step way but that may not be a real cure/treatment. Other treatment options include:
- Urethrotomy – the stricture is cut and a catheter is placed inside the urethra until the area heals.
- Surgery – Depending on the length of the constriction, incision is made in the perineum area and the part of the urethra is removed and reconnected. Substitution urethroplasty is a procedure where the repair is done in stages in cases of longer constrictions. Free grafting, skin flap and staged are three kinds of substitution procedures employed by surgeons to treat long urethral strictures.