Urethral Stricture

Overview

What is a Urethral Stricture?

  • A urethral stricture is a narrowing in the tube that passes urine from the bladder out through the penis.  
  • This is caused by scar tissue that causes a construction in the  tube called the urethra.
  • Strictures commonly affect the anterior urethra ( the part downstream from the prostate).  
  • The anterior urethra is composed of the penile urethra and the bulbar urethra (between scrotum and rectum)
  • Strictures can be mild or severe and affect the tissue surrounding the lining of the tube. 
  • Strictures can be caused by infections (inflammatory), prior instrumentation (iatrogenic), trauma, or sometimes the cause is unknown (idiopathic)

Signs & Symptoms

There may not be any symptoms initially. However, the following symptoms – which are likely to worsen with time – may occur:

  • Reduced urine flow is the usual first symptom.
  • Straining to pass urine or pain.
  • Spraying of urine or a double stream may occur.
  • Dribbling of urine after going to the toilet to pass urine.
  • Needing to pass urine more often than normal.
  • Reduced force of ejaculation.

Diagnosis & Treatment

Initial diagnostic testing

:

  • History and Physical exam
  • International Prostate Symptom Score (IPSS) 
  • Uroflow (this test measures the urine flow)
  • Post void residual (PVR) (this is a test to see if your bladder empties completely)


Advanced diagnostic testing

  • Cystoscopy
    • 5-10 minute office procedure to evaluate the urethra, prostate,  and bladder.   
  • Retrograde Urethrogram 
    • Contrast Dye is injected through the opening of the penis to distend the urethral and identify any areas of narrowing (stricture).
    • This is performed in the radiology suite and no anesthesia is required.
    • This is important for planning which surgical procedure is appropriate as well as identifying the stricture.

 

Treatment

Treatment is usually advised to improve the flow rate of urine, to ease symptoms and to prevent possible complications. Treatment options include the following:

  • Widening (dilatation) of the stricture. This is usually done by passing a thin plastic rod (boogie) into the urethra. This procedure may be done either under a local or a general anaesthetic.
  • Urethrotomy: A thin telescope is passed into the urethra to see exactly where the stricture is. This is done during a general anaesthetic. A tiny knife is then passed down the telescope to cut along the stricture. This widens the narrowed stricture. You will get relief of symptoms from this procedure. About half of people are cured for good by this procedure. However, the stricture may re-form and the procedure may have to be repeated from time to time in some cases.
  • Surgery: A corrective operation which is called a urethroplasty is performed if a urethrotomy does not work.  As a rule, there is a high success rate in curing symptoms with these operations.
  • Antibiotics: A long course of antibiotics may be advised to prevent urine infections until a stricture has been widened.