About Urethral Stricture

Urethral stricture is a condition often surrounded by stigma or discomfort in conversation, largely due to limited public awareness and understanding. Yet, it is a genuine medical issue that can greatly affect one’s quality of life. The condition can stem from several causes, including trauma, past surgeries, infections, inflammation, or the formation of scar tissue within the urethra. Urethral strictures occur in about 1 in 1,000 men, and recurrence is frequent following less invasive procedures like dilation or urethrotomy. Prompt diagnosis and proper management are vital to avoid complications such as chronic urinary tract infections (UTIs), bladder dysfunction, or potential kidney damage.

Signs and Symptoms of Urethral Stricture

• Weak or slow urine stream (like a trickle instead of a steady flow).
• Difficulty starting urination (hesitancy) or straining to urinate.
• Frequent urination, often with a sense of incomplete bladder emptying.
• Burning or pain during urination (dysuria).
• Blood in urine (hematuria) or semen.
• Spraying or splitting of the urine stream.
• In severe cases, urinary retention (inability to urinate), leading to bladder pain or swelling.

Urethral Stricture Causes

• Trauma or Injury: Pelvic fractures, straddle injuries (e.g., bicycle accidents), or catheter-related damage can scar the urethra.
• Infection: Untreated sexually transmitted infections (e.g., gonorrhea) or chronic urinary tract infections (UTIs) may inflame and narrow the urethra.
• Medical Procedures: Previous surgeries (e.g., prostate surgery, catheter use) can cause scar tissue formation.
• Congenital: Rarely, some individuals are born with a narrowed urethra.
• Cancer or Radiation: Urethral or prostate cancer, or radiation therapy, can lead to strictures as a side effect.

Urethral Stricture Risk Factors:

• Gender: More common in men due to longer urethras (women rarely affected).
• Age: Risk increases with age, especially after 50, often linked to prostate issues or prior interventions.
• History of Trauma: Past pelvic injuries or rough catheter insertions heighten risk.
• Infections: Recurrent UTIs or STDs increase likelihood.
• Prior Urologic Procedures: Men with a history of prostate surgery, TURP, or prolonged catheter use are at higher risk.

Urethral Stricture Diagnosis

• Medical History: Doctor reviews symptoms, past injuries, infections, or surgeries.
• Physical Exam: Checks for urethral discharge, prostate enlargement, or signs of trauma.
• Uroflowmetry: Measures urine flow rate and volume; a weak flow suggests obstruction.
• Post-Void Residual (PVR): Ultrasound assesses how much urine remains in the bladder after urination.
• Urethrography: X-ray with contrast dye (retrograde urethrogram) visualizes the stricture’s location and length.
• Cystoscopy: A thin scope inserted into the urethra directly views the narrowing.
• Urinalysis: Tests for infection or blood to rule out other conditions.

Urethral Stricture Treatment:

Urethroplasty: Urethroplasty is an open surgical procedure to repair or reconstruct a narrowed urethra (stricture) by removing or bypassing scar tissue, restoring normal urine flow.

Types of Urethroplasty

The specific technique depends on the stricture’s location (e.g., penile urethra, bulbar urethra, or posterior urethra), length, and severity. Common approaches include:

1. Anastomotic Urethroplasty

• Used for short strictures (usually <2 cm).
• The scarred section is cut out, and the healthy ends of the urethra are stitched together (end-to-end anastomosis).
• Best for strictures in the bulbar urethra (near the base of the penis).
• High success rate (up to 90-95%) but limited to shorter defects due to tension risks.

2. Substitution Urethroplasty (Graft or Flap)

For longer strictures (>2 cm) where removing the segment would leave too big a gap.
Tissue is taken from another part of the body to replace or patch the narrowed area:

Buccal Mucosa Graft: Tissue from the inner cheek is commonly used due to its resilience and similarity to urethral lining.
Skin Graft or Flap: Less common, using penile or scrotal skin.
The graft is sewn into place to widen or reconstruct the urethra.
Often used for penile or longer bulbar strictures.

3. Staged Urethroplasty

For very complex or recurrent strictures, especially after trauma or failed repairs.
Done in two phases:
Stage 1: The stricture is opened, and a temporary graft is placed to prepare the area.
Stage 2: Months later, the urethra is fully reconstructed once the tissue heals.

4. Common in cases with significant scarring or lichen sclerosus (a skin condition affecting the urethra).

Procedure Details

• Incision: Typically made on the perineum (between scrotum and anus) for bulbar strictures or along the penis for penile strictures.
• Catheter Use: A urethral catheter is placed post-surgery (for 1-3 weeks) to keep the repaired area open and allow healing.
• Duration: Surgery can take 2-6 hours, depending on complexity.
• Recovery: Hospital stay is usually 1-2 days, with full recovery in 4-8 weeks. Patients avoid strenuous activity during this time.

Advantages

• High Success Rate: Long-term success is 85-95%, far better than repeated dilations (20-40% success).
• Durability: Addresses the scar tissue directly, reducing recurrence compared to cutting or stretching methods.
• Improved Quality of Life: Restores normal urination, reducing infections, bladder issues, or kidney strain from obstruction.

When It’s Recommended

• Recurrent strictures after failed dilation/urethrotomy.
• Long or multiple strictures.
• Strictures from trauma (e.g., pelvic fracture), radiation, or congenital issues.
• Patients seeking a permanent solution over repeated procedures.

Medication Management:

• Management of Symptoms:
  • Medications (e.g., alpha-blockers) ease urine flow or antibiotics treat infections; not a cure but supportive.
• Emergency Care:
  • For complete blockage (urinary retention), a suprapubic catheter (through the abdomen) drains the bladder until definitive treatment.

*Consumption of medications under the advice of a doctor only.