A urethral stricture is a narrowing of the urethra, the tube through which urine exits the body. The condition occurs due to scarring caused by injury, infection, or inflammation. Most often, urethral strictures result from injuries sustained during trauma or a medical procedure. In lesser cases, they may develop due to an enlarged prostate (benign prostatic hyperplasia), tumor, birth defect, or sexually-transmitted disease.
Treatment of a urethral stricture depends upon its location along the urethra, as well as its severity. Underlying conditions like infections and inflammation can be treated with antibiotics and anti-inflammatories.
Urethral Stricture Treatment
Urethral dilation
Periodic stretching of the urethra (urethral dilation) may be an option for some people. During this procedure, which is done under general anesthesia, a metal tube is inserted into the urethra in order to stretch the area of the stricture. The surgeon begins with a small tube and gradually introduces tubes of greater size until a wide enough opening has been achieved. Newer techniques may use an inflatable balloon to widen the urethra.
Urethral dilation works best for people who have scarring only on the inner surface of the urethra (epithelium), rather than surrounding tissues like the spongy part of the penis (corpus spongiosum). If this method fails, surgery may be required.
The most common complication is a recurrence of the urethral stricture. Inserting the medical instruments can also cause additional injury to the urethra and surrounding tissue.
Internal urethrotomy
A urethral stricture can also be cut away using a knife or a laser fiber. This is done by way of an internal urethrotomy, which is performed under general anesthesia. Here, an endoscope (a thin tube with a light, camera and channel for small surgical tools) is inserted directly into the urethra. Once the stricture has been located and cut away, internal incisions are made. The endoscope is removed and a Foley catheter is guided up to the bladder and left in place for three to seven days to help with urine drainage and to keep the urethra from narrowing during its healing period.
The most common complications of this procedure is the return of the urethral stricture. Other problems include bleeding and leakage of irrigation fluid into tissue surrounding the urethra, mild burning upon passing urine, infection, and erectile dysfunction (rare).
Permanent urethral stents
Stents are small mesh tubes that can be inserted inside the urethra to keep it open. Over time, the stent becomes part of the inner lining of the urethral wall. Other stents are designed to be removed after a few months. Stents are most successful for shorter strictures that occur inside the part of the urethra that runs through the penis (bulbous urethra). They are also useful for patients who cannot undergo reconstruction of the urethra due to other medical conditions.
Complications associated with urethral stents include pain during intercourse or while sitting (when the stent is placed in the penis), movement of the stent inside the urethra, infection, leakage of urine, blood in the urine, urgency and frequency of urination, urethral irritation, and pain in the kidney, bladder or groin.
Open reconstruction surgery
For longer urethral strictures, open reconstruction (urethroplasty) may be needed. During this procedure, the scarred part of the urethra is removed and then either the healthy part of the urethra is reconnected or the urethra is reconnected using a graft taken from the cheek or other body part.
While bladder function is rarely affected, complications may include urinary tract infection and wound infections, chronic pain, injury to nearby organs, penile curvature, shortening of the penis, difficulty ejaculating or having an erection, and deceased sensitivity of the tip of the penis.
Prognosis after Urethral Stricture Treatment
The success rate of both urethrotomy and urethral dilation ranges from 10 to 90 percent, depending upon the length of the stricture. Repeated treatments may also have lower success rates, possibly due to additional scarring inside the urethra from the procedure. Permanent stents have been successful in up to 84 percent of patients. Some studies, however, found that temporary stents were less effective, although keeping the stent in longer than four months improved the success rate. The success rate of a urethroplasty depends upon many factors, including the location and size of the stricture, other treatments performed previously, and the experience of the surgeon. One study found that up to 91 percent of patients responded well after a single repair.
References
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Choi EK, Song HY, Shin JH, et al. (2007). Management of recurrent urethral strictures with covered retrievable expandable nitinol stents: long-term results. AJR Am J Roentgenol 189(6):1517-22.
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Heyns CF, Steenkamp JW, De Kock ML, et al. (1998). Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol 160(2):356-8.
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