Urethral stricture Health Article

Definition

Urethral stricture is an abnormal narrowing of the tube that carries urine out of the body from the bladder (urethra).

Causes, incidence, and risk factors

Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by pressure from an enlarging tumor near the urethra, although this is rare.

Other risks include:

• A history of sexually transmitted disease (STD)
• Any instrument inserted into the urethra (such as a catheter or cystoscope)
• Benign prostatic hyperplasia (BPH)
• Injury or trauma to the pelvic area
• Repeated episodes of urethritis

Strictures that are present at birth (congenital) are rare. Strictures in women are also rare.

Symptoms

• Blood in the semen
• Bloody or dark urine
• Decreased urine output
• Difficulty urinating
• Discharge from the urethra
• Frequent or urgent urination
• Inability to urinate (urinary retention)
• Incontinence
• Painful urination (dysuria)
• Pain in the lower abdomen
• Pelvic pain
• Slow urine stream (may develop suddenly or gradually)
• Spraying of urine stream
• Swelling of the penis

Signs and tests

A physical examination may show the following:

• Decreased urinary stream
• Discharge from the urethra
• Enlarged (distended) bladder
• Enlarged or tender lymph nodes in the groin (inguinal) area
• Enlarged or tender prostate
• Hardness (induration) on the under surface of the penis
• Redness or swelling of the penis

Sometimes the exam reveals no abnormalities.

Tests include the following:

• Cystoscopy
• Post-void residual (PVR) volume
• Retrograde urethrogram
• Tests for chlamydia and gonorrhea
• Urinalysis
• Urinary flow rate
• Urine culture

Treatment

The urethra may be widened (dilated) during cystoscopy by inserting a thin instrument to stretch the urethra while you are under local anesthesia. You may be able to treat your stricture by learning to dilate the urethra at home.

If urethral dilation is not possible, you may need surgery to correct the condition. Surgical options depend on the location and length of the stricture. If the stricture is short and not near the urinary sphincter, options include cutting the stricture via cystoscopy or inserting a dilating device.

An open urethroplasty may be done for longer strictures. This surgery removes the diseased part or replaces it with other tissue. The results vary depending on the size and location, the number of treatments you have had, and the surgeon's experience.

In cases of acute urinary retention, a suprapubic catheter may be placed as an emergency treatment. This allows the bladder to drain through the abdomen.

There are currently no drug treatments for this disease. If all else fails, a urinary diversion -- appendicovesicostomy (Mitrofanoff procedure) -- may be done. This allows you to perform self-catheterization of the bladder through the wall of the abdomen.