Infectious Diseases / Bacteria / Viruses Urology / Nephrology

Urethral stricture: Everything you need to know

The urethra is the thin tube that carries urine from the urinary bladder out of the body. A urethral stricture is when narrowing from scar tissue occurs in the urethra.

Urethral strictures can obstruct the ability to urinate and cause urine to back up in the urinary tract. This can lead to kidney damage.

In this article, we cover the causes and symptoms of urethral stricture, as well as diagnosis and treatment of the condition.

Causes

Urethral stricture
Symptoms of urethral strictures include pain and discomfort when urinating.

Urethral manipulation is one of the most common causes of urethral strictures. Urethral manipulation can include:

  • a history of prostate brachytherapy, a type of cancer treatment
  • a history of prostatectomy
  • damage from an indwelling urethral catheter
  • correction of hypospadias

Hypospadias is a congenital abnormality in which the urethral opening exits through the underside of the penis instead of at its tip.

An estimated 45 percent of urethral strictures occur due to urethral manipulation for treatment, while 30 percent are due to unknown causes. Another 20 percent are due to bacterial infections causing inflammation in the urethra.

Some inflammatory conditions can also cause urethral strictures. These include untreated sexually transmitted infections (STIs) such as gonorrhea and chlamydia and a condition called balanitis xerotica obliterans.

Symptoms

Symptoms of urethral strictures include:

  • feeling as though the bladder is not empty after urinating
  • frequent urinary tract infections (UTIs)
  • increased urinary frequency
  • loss of bladder control
  • pain when urinating
  • swelling of the penis or surrounding structures
  • taking longer than usual to urinate
  • urinary urgency

Without treatment, urethral strictures can cause severe associated urinary system effects, such as kidney infections and kidney stones.

If a person experiences chronic urinary retention, their bladder may enlarge and become dysfunctional over time.

Differences in males and females

Urethral strictures are much more common among males than females. A male’s urethra is much longer than a female’s, so it is more prone to injury and damage that could lead to strictures.

Types in men

Healthcare professionals usually classify urethral strictures by where they occur in the male urethra.

  • Posterior urethra stricture: The posterior urethra is about 1–2 inches long and passes from the bladder opening to the portion of the urethra through the prostate and pelvic floor muscles. Posterior strictures are most commonly due to injury to the pelvis, such as a pelvic fracture.
  • Anterior urethra stricture: The anterior urethra is the portion downstream from the posterior section, comprising the last 9–10 inches of the male urethra. The most common causes of anterior urethral strictures include having a history of urinary catheterization, sustaining a straddle injury, or experiencing direct trauma to the penis.

A doctor will use diagnostic tests to determine what stricture type a male has.

Occurrence in females

Around 2.7–8 percent of females with bothersome lower urinary tract symptoms have urinary bladder outlet obstruction. A subsequent 4–18 percent of these women have a urethral stricture.

The causes of urethral stricture in females are similar to those in males.

Diagnosis

Urethral stricture mri
Imaging studies, such as MRI scans, can identify urethral problems.

A doctor will first take a full medical history to help diagnose the underlying cause of urethral strictures.

They will ask about a person’s symptoms, when they started, and what makes them worse or better.

For males, a doctor will also conduct a physical exam to see whether there are any visible injuries or deformities to the penis. They may also recommend various testing methods to identify urethral problems. Tests include:

  • Urethroscopy: During this test, a doctor inserts a thin lighted scope into the urethra to see where the urethral stricture has occurred.
  • Retrograde urethrogram: In a retrograde urethrogram, a doctor inserts special contrast dye into the urethra at the tip of the penis and watches where the dye progresses using a fluoroscopic X-ray device.
  • Imaging studies: Imaging studies, such as MRI scans, CT scans, and ultrasounds, let doctors view the urethra and surrounding structures.

A doctor will use information from diagnostic studies to determine the severity of the urethral stricture and how it impacts surrounding structures.

Treatment

Treatment for urethral strictures depends on where they occur, what symptoms they cause, and a person’s overall health.

If a person does not have significant symptoms, a doctor may recommend watchful waiting to see whether it heals.

If a person has significant urinary retention, a doctor may recommend inserting a special catheter called a suprapubic catheter.

This is a catheter that doctors use if they cannot insert an indwelling urinary catheter through the urethral opening. Instead, the catheter goes into the urinary bladder through the abdomen, above the pubic bone.

Examples of other treatments for a urethral stricture include:

  • Dilation: Dilating the urethral stricture involves inserting special devices to enlarge the stricture with gradual stretching. Doctors often recommend this approach as an initial step, as it is the least invasive and can be effective for both males and females.
  • Urethrotomy: This approach involves surgically cutting the stricture with a special laser or scalpel with urethroscopic guidance.
  • Open surgical removal: This is the most invasive approach to correcting urethral strictures. It involves surgically removing them and potentially using grafts or other reconstructive procedures on the urethra.

Urethral strictures can reoccur, even after treatment. If this happens, a person may require follow-up surgical interventions.

Prevention

Urethral stricture condom
Using barrier protection during sexual activity can help prevent urethral strictures.

Preventing a urethral stricture is not always possible. However, there are some steps a person can take to reduce the chance that they will develop one.

The following are some ways to help prevent urethral strictures:

  • If a person must self-catheterize (insert a catheter themselves to eliminate urine), use lubricating jelly and the smallest possible catheter for the shortest time frame possible.
  • Use barrier protection during sexual activity to help prevent the transmission of chlamydia or gonorrhea.
  • Avoid having sexual intercourse with partners who have an infection.
  • Get tested regularly for STIs, including gonorrhea and chlamydia, and seek the appropriate treatment.

Taking steps to prevent pelvic injuries, such as wearing appropriate protective equipment when playing sports, can also help prevent urethral strictures.

Summary

Urethral strictures can be a troublesome occurrence for males and females. They are much more likely to occur in males.

Treatments range from watchful waiting to surgical approaches. As strictures are likely to reoccur, it is essential for a person to continue to follow up with their urologist and monitor for symptoms, even after treatment.

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