he urethra’s main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
Causes
Men are more likely to have a urethral disease or injury because of their longer urethra. For this reason, strictures are more common in men. They are rare in women and in infants.
Stricture (narrowing of the urethra) can happen at any point from the bladder to the tip of the penis. This narrowing restricts or slows the flow of urine in. Some common causes are:
- trauma to the urethra
- infection such as a sexually transmitted disease
- damage from surgical tools
- conditions that cause swelling
In most cases, no cause can be found.
In adults, urethral strictures are most often due to:
- injury from a fall onto the scrotum or perineum
- prostate surgery
- kidney stone removal
- urinary catheterization
- other surgical tools
Posterior Urethral Stricture
Posterior urethral strictures happen in the first 1″ to 2″ of the urethra. This kind of stricture is due to an injury linked to a pelvic fracture (e.g., motor vehicle or industrial accident). In these cases the urethra is disrupted, or completely cut and separated. Urine cannot pass. A catheter must be placed either through the abdomen into the bladder (suprapubic tube), or through the penis into the bladder. This lets urine drain until the stricture can be fixed.
Anterior Urethral Stricture
Anterior urethral strictures happen in last 9″ to 10″ of the urethra. This kind of stricture is caused by:
- trauma from a straddle injury (from falls onto objects where the legs are on either side)
- direct trauma to the penis
- catheterization
Symptoms
Simply put, the urethra is like a garden hose. When there is a kink or narrowing along the hose, no matter how short or long, the flow is reduced. When a stricture is narrow enough to decrease urine flow, you will have symptoms. Problems with urinating, UTIs, and swelling or infections of the prostate may occur. Severe blockage that lasts a long time can damage the kidneys.
Some signs are:
- bloody or dark urine
- blood in semen
- slow or decreased urine stream
- urine stream spraying
- pain with urinating
- abdominal pain
- urethral leaking
- UTIs in men
- swelling of the penis
- loss of bladder control
Diagnosis
There are several tests to determine if you have a urethral stricture including:
- physical exam
- urethral imaging (X-rays or ultrasound)
- urethroscopy (to see the inside of the urethra)
- retrograde urethrogram
Urethroscopy
The doctor gently places a small, bendable, lubricated scope ( a small viewing instrument) into the urethra. It is moved up to the stricture. This lets the doctor see the narrowed area. This is done in the office and helps your doctor decide how to treat the stricture.
Retrograde Urethrogram
This test is used to see how many strictures there are, and their position, length and severity. This is done as an outpatient X-ray procedure. Retrograde in this case means “against the flow” of urine. Contrast dye (fluid that can be seen on an X-ray) is inserted into the urethra at the tip of the penis. No needles or catheters are used. The dye lets the doctor see the entire urethra and outlines the narrowed area. It can be combined with an antegrade urethrogram (antegrade means “with the flow” of urine). Dye inserted from below fills the urethra up to the injured area. Dye inserted from above fills the bladder and the urethra down to the stricture. These tests together let the doctor find the gap to plan for surgery.
Also, if you have trauma to the urethra, you may have this X-ray procedure after emergency treatment. Contrast dye can be injected through the catheter that was placed for healing.
Treatment
There are many options depending on the size of the blockage and how much scar tissue is involved.
Treatments include:
- dilation – enlarging the stricture with gradual stretching
- urethrotomy – cutting the stricture with a laser or knife through a scope
- open surgery – surgical removal of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty)
There are no available drugs to help treat strictures.
Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can’t pass urine), which could lead to an enlarged bladder and kidney problems.