Urethral Stricture Disease

As an important part of the urinary tract in both men and women, the urethra’s primary purpose is to empty the bladder. A urethral stricture is caused by urethral scar tissue buildup that can block the flow of urine. Urethral strictures are much more common in men because their urethras are longer than women’s, thus they are more susceptible to disease or injury.

Symptoms may include slow urine streams, painful urination, or the total inability to urinate. There may be hematuria (blood in the urine) and abdominal pain. Men often experience recurrent urinary tract infections (UTIs) and urethral discharge. It’s important to disclose these symptoms to your doctor so they can diagnose whether you have urethral stricture disease or something else.

Causes of Urethral Stricture Disease

Urethral stricture disease can be caused by trauma, chronic inflammation from sexually transmitted infections/diseases (STIs/STDs), frequent urologic surgery, or radiation from prostate cancer treatment. Additionally, some men present with an idiopathic (unknown) form of urethral stricture disease. For example, bicycle straddle injury can lead to urethral strictures in men. Repeated treatments with surgical instruments to remove kidney stones and trauma from difficult urinary catheterization can also cause urethral strictures in men.

Diagnosis

Your doctor will first perform a complete physical exam as well as recommend and perform a urethral imaging study such as X-ray or ultrasound of the urethra. Other tests may include diagnostic tests called retrograde urethrogram or urethroscopy. In retrograde urethrogram, the urologist visualizes any structural abnormalities in the urethra such as narrowed areas or blockages. The location and size of the stricture is documented to serves as a “roadmap” for planning surgery. Your doctor will inject a dye into the urethra and x-rays are taken to view the entire urethra. Urethroscopy involves the insertion of a small, flexible telescope into the urethra. This study allows your doctor to see inside the urethra from the tip of the penis to the location of the stricture.

Treatment

There are several options for treatment of urethral stricture disease. The type of procedure your doctor selects depends upon the length, location, and extent of scar tissue associated with the stricture. Your doctor may dilate the stricture to enlarge it, cut the stricture through a scope with a knife (urethrotomy), or surgically remove the diseased segment with reconnection and reconstruction possibly with flaps or grafts. Current research shows that dilations and/or urethrotomies have high failure rates and often the strictures recur with longer lengths and more dense scarring.

The alternative to dilations or urethrotomies is urethroplasty, which has higher cure rates and benefits for patients. Urethroplasty is the surgical removal of the urethral stricture. Reconstructive urologists use various techniques, including penile skin flaps and extra-genital skin (skin lining inside of the mouth), grafts in urethroplasty. Patients with recurrent urethral stricture disease often get urethroplasty to repairs the scarred urethra to restore normal urine flow.