Urethral stricture

Overview

A urethral (u-REE-thrul) stricture involves scarring that narrows the tube that carries urine out of the body, called the urethra. As a result of a stricture, less urine comes out of the bladder. This can cause problems in the urinary tract, such as infection.

Symptoms

Symptoms of urethral stricture can include:

• Weak urine stream.
• Bladder not emptying all the way.
• Spraying urine.
• Finding it hard or painful to pass urine.
• Passing urine more often or feeling the need to pass urine more often.
• Urinary tract infection.

Causes

Scar tissue, which can narrow the urethra, can be due to:

• A medical procedure that involves putting a tool, such as an endoscope, into the urethra.
• A tube that's put into the urethra to drain the bladder, called a catheter.
• Trauma or injury to the urethra or pelvis.
• An enlarged prostate or having had surgery to remove or reduce an enlarged prostate gland.
• Cancer of the urethra or prostate.
• Sexually transmitted infections.
• Radiation therapy.
• A skin condition that causes patchy, discolored, thin skin that often affects the genital area, called lichen sclerosus.

Urethral stricture is much more common in males than in females. Often the cause is unknown.

Diagnosis

To make a diagnosis, a member of your health care team will ask about your symptoms and your medical history and do an exam. Tests that can help find where the stricture is, how long it is and what's causing it might include:

• Urine tests. These look for infection, blood or cancer in the urine.
• Urinary flow test. This measures the urine flow and how strong it is.
• Urethral ultrasound. This shows how long the stricture is.
• Pelvic ultrasound. This looks at whether there's still urine in the bladder after emptying it.
• Pelvic MRI scan. This looks at the pelvic bone to see how it's involved with the condition.
• Retrograde urethrogram. This test uses X-ray images to look for a problem or injury of the urethra. It also shows how long the stricture is and where it is.
• Cystoscopy. This uses a thin, tubelike tool that has a lens, called a cystoscope. The tool looks inside the urethra and bladder.

Treatment

Treatment might depend on the type of stricture, its size and how bad the symptoms are. Treatments can include:

• Catheterization. Putting a small tube called a catheter into the bladder to drain urine is often the first step for treating urine blockage. Antibiotics treat an infection if there is one. Self-catheterization might be a choice for those diagnosed with a short stricture.
• Widening, called dilation. This starts with a tiny wire put through the urethra and into the bladder. Larger and larger dilators pass over the wire to increase the size of the opening of the urethra little by little. This outpatient procedure may be a choice to treat recurrent urethral strictures.

• Urethroplasty. This involves surgically removing the narrowed section of the urethra or making it larger. The procedure might also involve rebuilding tissues around the urethra.

  Tissues from other areas of the body, such as the skin or mouth, may be used as a graft during the process. The chance of urethral stricture coming back after a urethroplasty is low.

• Endoscopic urethrotomy. This procedure uses a thin, tubelike tool that has a lens, called a cystoscope. The cystoscope goes into the urethra. Then a tool is put through the cystoscope to remove the stricture or treat it with a laser.

  This surgical procedure has a faster recovery than do some other procedures. It doesn't leave much scarring, and the risk of infection is low. However, urethral stricture can come back after this procedure.

• Implanted stent or long-term catheter. This treatment might be for people with a severe stricture who don't want surgery. A tube, called a stent, is put into the urethra to keep it open, Or a permanent catheter is put in to drain the bladder.

  These procedures have a risk of bladder irritation, discomfort and urinary tract infections. They also need to be watched closely. Urethral stents are rarely used.