Urethral Stricture Disease

What is Urethral Stricture Disease?

The urethra’s main job in men and women is to pass urine outside the body. This thin tubealso has an important role in ejaculation for men. When a scar from swelling, injury orinfection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Formore information, you can visit: https://www.urologyhealth.org/urology-a-z/u/urethral-stricture-disease.

What Happens under Normal Conditions?

The bladder empties through the urethra and out of the body (called voiding or urinating). The female urethra is much shorter than the male’s. In males, urine must travel a longer distance from the bladder through the penis. In males, the first 1-2 inches of the urethra that urine passes through is called the posterior urethra. The posterior urethra includes:

• the bladder neck (the opening of the bladder)

• the prostatic urethra (the part of the urethra by the prostate)

• the membranous urethra

• a muscle called the external urinary sphincter

In males, the final 9-10 inches of the urethra is called the anterior urethra. The anterior urethra includes:

• the bulbar urethra, under the scrotum and perineum (the area between the scrotum and anus)

• the penile urethra (along the bottom of the penis)

• the meatus (the exit at the tip of the penis)

Strictures can happen in either the posterior or anterior urethra.

Causes

Men are more likely to have a urethral disease or injury because of their longer urethra. For this reason, strictures are more common in men. They are rare in women and in infants. Stricture (narrowing of the urethra) can happen at any point from the bladder to the tip of the penis. This narrowing restricts or slows the flow of urine in. Some common causes are:

• trauma to the urethra (example: injury from a fall on the scrotum or perineum). For more information, you can visit: https://www.urologyhealth.org/urology-a-z/u/urethral-trauma.

• infections (example: sexually transmitted disease)

• damage from surgical tools or procedures (example: prostate surgery, kidney stone removal, urinary catheterization)

• conditions that cause swelling

• in most cases, no cause can be found.

Posterior Urethral Stricture:

Posterior urethral strictures happen in the first 1-2 inches of the urethra. This kind of stricture can be due to an injury linked to a pelvic fracture (example: motor vehicle or industrial accident). In these cases, the urethra is disrupted, or completely cut and separated. Urine cannot pass. A catheter must be placed either through the abdomen into the bladder (suprapubic tube), or through the penis into the bladder. This lets urine drain until the stricture can be fixed.

Anterior Urethral Stricture:

Anterior urethral strictures happen in last 9-10 inches of the urethra. This kind of stricture can be caused by trauma from a straddle injury (from falls onto objects where the legs are on either side), direct trauma to the penis or even urethral catheterization. Simply put, the urethra is like a garden hose. When there is a kink or narrowing along the hose, no matter how short or long, the flow is reduced. When a stricture is narrow enough to decrease urine flow, you will have symptoms.

Signs and symptoms include:

• bloody or dark urine

• blood in semen

• slow or decreased urine stream

• urine stream spraying

• pain with urinating

• abdominal pain

• urethral leaking

• urinary tract infections in men

• swelling of the penis

• loss of bladder control

• swelling or infections of the prostate

• damage to the kidneys (if blockage is severe and long lasting)

Diagnosis

There are several tests to determine if you have a urethral stricture including:

  • physical exam

  • urethral imaging

  • Retrograde Urethrogram (also called “RUG”) - This test is used to see how many strictures there are, and their position, length and severity. This is done as an outpatient X-ray procedure. Retrograde in this case means “against the flow” of urine. Contrast dye (fluid that can be seen on an X-ray) is inserted into the urethra at the tip of the penis. No needles or catheters are used. The dye lets the doctor see the entire urethra and outlines the narrowed area. It can be combined with an antegrade urethrogram (antegrade means “with the flow” of urine). Dye inserted from below fills the urethra up to the injured area.

  • dye inserted from above fills the bladder and the urethra down to the stricture. These tests together let the doctor find the gap to plan for surgery. Also, if you have trauma to the urethra, you may have this X-ray procedure after emergency treatment. Contrast dye can be injected through the catheter that was placed for healing. For more information, you can visit: https://www.urologyhealth.org/urology-a-z/r/retrograde-urethrogram

  • urethroscopy: The doctor gently places a small, bendable, lubricated cystoscope (a small viewing instrument) into the urethra. It is moved up to the stricture. This lets the doctor see the narrowed area. This is done in the office and helps your doctor decide how to treat the stricture.

Treatments

  • dilation – enlarging the stricture with gradual stretching either in the office or operating room

  • urethrotomy – cutting the stricture with a laser or knife through a scope in the operating room

  • Optilume– balloon dilation and intraurethral treatment with an anti-scar drug (paclitaxel) in the operating room. For more information, you can visit: https://www.laborie.com/patients/conditions/urethral-stricture/

  • open surgery – surgical removal of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty)

    Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can’t pass urine), which could lead to an enlarged bladder and kidney problems.