Urethral Stricture

A urethral stricture is a narrowing of the urethra, which is the tube that carries urine from the bladder out of the body. This condition can restrict the flow of urine and cause a variety of urinary problems.

Causes

  1. Trauma or Injury:

    • Injury to the urethra or pelvis, such as from falls, car accidents, or straddle injuries.

  2. Infections:

    • Sexually transmitted infections (STIs) like gonorrhea or chlamydia.

    • Recurrent urinary tract infections (UTIs).

  3. Medical Procedures:

    • Insertion of catheters or surgical instruments into the urethra.

    • Complications from prostate or urethral surgery.

  4. Inflammatory Conditions:

    • Conditions like lichen sclerosus or balanitis xerotica obliterans that cause scarring and narrowing.

  5. Radiation Therapy:

    • Radiation treatment for pelvic cancers can lead to scarring and stricture formation.

  6. Congenital Abnormalities:

    • Some individuals are born with a narrow urethra.

Symptoms

  • Decreased urine stream.

  • Difficulty or straining to urinate.

  • Spraying or splitting of the urine stream.

  • Frequent urination.

  • Urgent need to urinate.

  • Pain during urination.

  • Incomplete bladder emptying.

  • Recurrent urinary tract infections.

  • Blood in the urine (hematuria).

Diagnosis

  1. Medical History and Physical Examination:

    • Detailed history of symptoms, any previous injuries, surgeries, or infections.

    • Physical examination, including a genital and rectal exam.

  2. Urine Flow Test (Uroflowmetry):

    • Measures the strength and amount of urine flow. A reduced flow rate may indicate a stricture.

  3. Post-Void Residual Measurement:

    • Measures the amount of urine left in the bladder after urination using ultrasound or catheterization.

  4. Retrograde Urethrogram (RUG):

    • An X-ray test where contrast dye is injected into the urethra to visualize the stricture.

  5. Cystoscopy:

    • A thin, flexible tube with a camera (cystoscope) is inserted into the urethra to directly visualize the stricture.

  6. Urethral Ultrasound:

    • Used to assess the length and location of the stricture.

Treatment Options

The choice of treatment depends on the severity, length, and location of the stricture, as well as the patient’s overall health.

  1. Dilation:

    • Gradual stretching of the stricture using progressively larger dilators.

    • Can be performed under local anesthesia.

    • Often provides temporary relief and may need to be repeated.

  2. Urethrotomy:

    • An endoscopic procedure where the stricture is cut internally using a special instrument called a urethrotome.

    • Performed under general or regional anesthesia.

    • Effective for short strictures but may recur.

  3. Catheterization:

    • Temporary placement of a catheter to bypass the stricture.

    • Can help relieve symptoms and allow urine to flow.

  4. Stent Placement:

    • Insertion of a small, expandable tube (stent) to keep the urethra open.

    • Used less frequently due to potential complications.

  5. Urethroplasty:

    • Surgical reconstruction of the urethra.

    • Primary Excision and Anastomosis: Removal of the narrowed segment and rejoining the healthy ends.

    • Graft Urethroplasty: Using tissue grafts from other parts of the body (such as the mouth) to reconstruct the urethra.

    • Considered the gold standard for long-term success, especially for longer or recurrent strictures.

  6. Perineal Urethrostomy:

    • Creation of a new opening for urine to exit through the perineum (the area between the scrotum and the anus).

    • Typically reserved for severe cases or when other treatments have failed.

Post-Treatment Care

  • Regular follow-up to monitor for recurrence.

  • Uroflowmetry and cystoscopy to assess the urethra.

  • Managing and preventing infections.

  • Hydration and avoiding activities that may cause trauma to the urethra.

Complications

  • Recurrence of the stricture.

  • Urinary retention.

  • Urinary tract infections.

  • Bladder or kidney damage from chronic urinary obstruction.

Prevention

  • Prompt treatment of urinary tract infections.

  • Safe practices to avoid sexually transmitted infections.

  • Careful management and insertion of catheters.

  • Avoidance of activities that may cause pelvic or urethral trauma.

Conclusion

Urethral strictures can significantly impact urinary function and quality of life. Early diagnosis and appropriate treatment are essential for effective management.

Dr. Saurabh Mishra and his team provide comprehensive care for patients with urethral strictures, offering a range of treatments tailored to individual needs to ensure the best possible outcomes.