What is Urethral Stricture?
A urethral stricture is scarring in or around the urethra that narrows or blocks the passageway through which urine flows from the bladder. The stricture results from inflammation, infection or injury, and is much more common in men than in women. The scarring can occur anywhere between the bladder and the tip of the penis. In addition to uncomfortable urinary symptoms such as reduced flow rate and more frequent urination, a urethral stricture can lead to complications that include urinary tract infections, prostatitis, urinary retention and kidney damage.
Anatomy and Causes
For men, as urine makes its way into the urethra on its way out of the body, it passes through the bladder neck into the portion of the urethra surrounded by the prostate. It then enters a section called the membranous urethra, which includes a muscle called the external urinary sphincter. Contracting this muscle is how we hold in urine or stop its flow. Stricture in this area, called the posterior urethra, most commonly results from an injury associated with a pelvic fracture, such as from an automobile or industrial accident. The area from the sphincter to the tip of the penis is called the anterior urethra. Strictures not caused by pelvic injury tend to occur in this area. Among the most common causes are “straddle” injuries, such as the bruising from falling onto a crossbar. As such injuries heal, scarring in the form of a stricture can develop. Trauma resulting from placement of a catheter, endoscope, or other foreign body into the area can also induce urethral stricture. Other potential causes are sexually transmitted diseases such as gonorrhea or chlamydia, and other inflammatory conditions. Urethral strictures sometimes occur after prostate surgery or removal of kidney stones, or following reconstructive surgery for congenital abnormalities in children. In many cases, though, the cause is not apparent.
Urethral Stricture Symptoms and Diagnosis
Symptoms of urethral strictures are mostly urinary – painful urination, reduced urine output, slow urine stream, spraying of the stream, incomplete emptying of the bladder, and inability to void. Urinary tract infections are also common, and blood will occasionally appear in the urine. Diagnostic tests include urinalysis, urine cultures, uroflowmetry studies measuring the flow from the bladder, and post-void residual studies, in which an ultrasound measures the amount that is left after a normal voiding.
Treatment for Urethral Stricture
The retrograde urethrogram and antegrade urethrogram are imaging techniques that can help to pinpoint the length, position, and severity of the stricture. This also helps to guide the treatment course. Among the many approaches to treating strictures are gradually stretching them, a process called dilation; cutting the stricture with a laser or knife using a specially designed cystoscope (urethrotomy); and surgically removing the stricture and then reconstructing the area with grafts (anastomotic urethroplasty). The choice of treatment depends largely on the severity of the stricture. In minor cases in which the complication risk is low, doing nothing may be the best option; more moderate or severe cases are best addressed using either a minimally invasive or open surgical approach.
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