A urethral stricture is a narrowing of the urethra, the passageway through which urine flows from the bladder to outside of the body (through the tip of the penis in men or above the vaginal opening in women). It results after an injury, infection, or bout of inflammation. In the body's effort to correct the damage, scar tissue develops and builds in the tissues that surround the urethra, causing the tube to narrow or, in more severe cases, completely close. Constriction can occur at any point along the urethra.
The condition, which is much more common in men than women, can cause uncomfortable urinary symptoms, such as frequent urination and a decreased or absent flow of urine. A urethral stricture can also lead to other complications like urinary retention, inflammation of the prostate gland in men (prostatitis), urinary tract infections (UTIs), and damage to the kidneys.
Urethral Stricture Causes
The most common causes of urethral stricture are injury, or damage caused by a medical procedure/treatment, such as inserting a catheter (tube) in the urethra to assist with urination. Another cause is benign prostatic hyperplasia (BPH), in which the prostate enlarges and presses on the urethra. Less-frequent sources include infections, inflammation, a tumor pressing on the urethra, and congenital conditions that are present at birth.
Trauma. Damage to the urethra near the bladder (posterior urethra) can occur due to a pelvic fracture, such as those from an industrial or automobile accident; while injury to the portion of the urethra that extends to the tip of the penis (anterior urethra) is often caused by bruising from “straddle” injuries, such as falling onto a crossbar.
Medical procedures. Injuries from medical procedures—including inserting a catheter or endoscope—often occur in the anterior part of the urethra, as well. Urethral stricture can also occur after a radical prostatectomy (removal of the prostate), reconstructive surgery, kidney stone removal, or transurethral resection of the prostate (TURP).
Infection and inflammation. Urinary tract infections, infections caused by excessive catheterization, and sexually transmitted diseases (such as chlamydia or gonorrhea) can cause narrowing and inflammation of the urethra.
Urethral Stricture Symptoms
The symptoms of urethral stricture include:
- Painful urination
- Reduced volume of urine
- Decreased speed of urine flow
- Spraying of urine
- Incomplete bladder emptying
- Blood in the urine (due to a urinary tract infection)
Urethral Stricture Diagnosis
Doctors use a variety of methods to diagnose a urethra stricture, including:
- Physical exam to check for decreased urine flow, discharge from the urethra due to infection, an enlarged bladder or prostate, redness or swelling of the penis
- Urinalysis to look for signs of infection and blood in the urine
- Urine cultures to look for signs of infection
- Uroflowmetry studies to measure the flow of urine from the bladder
- Cystoscopy to look inside the urethra using a tube with a camera and a light
- Post-void residual studies to measure the amount of urine remaining in the bladder after urination
Urethral Stricture Treatment
There are several ways to treat a urethral stricture, depending on location and severity of the constriction. This may include stretching the urethra or cutting the stricture with a laser or a knife, as well as treatment of an infection.
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Brill JR. (2010). Diagnosis and treatment of urethritis in men. Am Fam Physician 81(7):873-8.