Figure 1: A stricture or scar that narrows the urethra and causes blockage of urinary flow (view through a scope in the urethra passed via the penis; also called cystoscopy)
A stricture is a dense scar that occurs somewhere along the urethra. The urethra is the urinary channel that starts in the bladder, travels through the prostate, and out the penis. Urethral strictures occur in about one of 200 men. Strictures can occur anytime in life and cause obstruction of the urinary flow.
Men with strictures often note symptoms such as poor urinary flow, painful urination, retained urine, and painful ejaculation. One of the more common symptoms is urinary tract infection. If you feel you have symptoms or have been diagnosed with a uretheral stricture, the reconstructive urologists in our clinic can help you decide on solutions and treatment options for this condition.
The causes of a urethral stricture cannot always be found. Some of the common causes are:
- Trauma, either a pelvic fracture or a blow to the perineum (the area between the scrotum and the anus),
- Serious infections of the urinary tract,
- Trauma from urinary catheter placement,
- Scarring from urologic procedures, or
- Previous surgery for hypospadias.
A urethral stricture is usually diagnosed based upon either x-rays of the urethra or a cystoscope procedure. In the x-ray procedure there are two types that can be done, which are a retrograde urethrogram and a voiding cystourethrogram. In these x-rays contrast dye is injected via a catheter into the urethra or into the bladder and images of the urethral stricture is obtained.
These x-rays help determine the diameter of the strictures as well as its length. A cytoscopic procedure is often used as an initial diagnostic procedure. A urologist can pass a flexible scope (similar to a catheter) up the urethra from the penis and find a stricture by visualizing its opening.
There are a variety of treatments for urethral strictures from procedures to internally cut or break open the scar to surgery.
Often patients are treated initially with one of the internal procedures. The internal procedures are referred to as endoscopic treatments and include urethral dilation and direct vision internal urethrotomy. Dilation of the urethra involves passage of a shaped metal rod or other instrument to break open the stricture internally.
Direct vision internal urethrotomy involves cutting the stricture with a very small knife that emerges from a scope placed into the urethra. Both methods have approximately the same success.
When strictures are short, dilation or direct internal vision urethrotomy may achieve a long-term success in about one third of patients. When strictures recur after an initial endoscopic procedure additional treatment from this method is very rarely successful.
Surgery for urethral strictures, or urethroplasty, is varied and involves many different techniques. If strictures are short and in certain portions of the urethra, the area of the urethra can be surgically removed and the healthy urethra can be reconnected. If the urethral stricture is lengthy, then other tissues need to be used to reconstruct the urethra.
One common tissue used in surgery for longer strictures is the lining of the inner cheek; this is referred to as buccal mucosa. Buccal mucosa has a tissue characteristic very similar to the native lining of the urethra and the mouth heals very well after harvest of this graft. Other options that are used for lengthy strictures include a piece of the penile skin. This is referred to as a penile circular fasciocutaneous flap and can be used on strictures that stretch throughout the penis.
Close follow-up and appropriate treatment of urethral strictures is very important in order to avoid the serious complications that can result like kidney failure, chronic urinary retention, or life threatening infections.
Bladder Augmentation, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Female Incontinence, General Urology, Mesh Erosion, Neurogenic Bladder, Pelvic Fractures and Urethral Injury, Radiation Injuries, Trauma and Reconstructive Urology, Ureteral Stricture, Urethral Stricture, Urinary Diversion, Urinary Strictures and Fistula, Urology, Vesicovaginal Fistula
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