A urethral (u-REE-thrul) stricture involves scarring that narrows the tube that carries urine out of your body (urethra). A stricture restricts the flow of urine from the bladder and can cause a variety of medical problems in the urinary tract, including inflammation or infection.
Signs and symptoms of urethral stricture include:
- Decreased urine stream
- Incomplete bladder emptying
- Spraying of the urine stream
- Difficulty, straining or pain when urinating
- Increased urge to urinate or more-frequent urination
- Urinary tract infection
Scar tissue, which can narrow the urethra, can be due to:
- A medical procedure that involves inserting an instrument, such as an endoscope, into the urethra
- Intermittent or long-term use of a tube inserted through the urethra to drain the bladder (catheter)
- Trauma or injury to the urethra or pelvis
- An enlarged prostate or previous surgery to remove or reduce an enlarged prostate gland
- Cancer of the urethra or prostate
- Sexually transmitted infections
- Radiation therapy
Urethral stricture is much more common in males than in females. Often the cause is unknown.
To make a diagnosis, your doctor will ask about your symptoms and your medical history and conduct a physical exam. Your doctor might recommend a number of tests to determine the cause, location and length of the urethral stricture, including:
- Urinalysis — looks for signs of infection, blood or cancer in your urine
- Urinary flow test — measures the strength and amount of urine flow
- Urethral ultrasound — evaluates the length of the stricture
- Pelvic ultrasound — looks for the presence of urine in your bladder after urination
- Pelvic magnetic resonance imaging (MRI) — assesses whether your pelvic bone is affecting or is affected by your condition
- Retrograde urethrogram — uses X-ray images to check for a structural problem or injury of the urethra as well as the length and location of the stricture along the urethra
- Cystoscopy — examines your urethra and bladder using a thin, tubelike device fitted with a lens (cystoscope) to view these organs
Corrective treatment at Mittal Clinic is necessary only if your stricture causes problems. If you do undergo treatment, you’ll need frequent follow-up exams for at least a year to ensure the stricture doesn’t recur and that you remain free of infection.
Your treatment will depend on your situation. Treatment options at Mayo Clinic include:
- Catheterization. Inserting a small tube (catheter) into your bladder to drain urine is the usual first step for treating urine blockage. Your doctor might also recommend antibiotics to treat an infection, if one is present. Self-catheterization might be an option if you’re diagnosed with a short stricture.
- Dilation. Your doctor inserts a tiny wire through the urethra and into the bladder. Progressively larger dilators pass over the wire to gradually increase the size of the urethral opening. This outpatient procedure may be an option for recurrent urethral strictures.
- Urethroplasty. This involves surgically removing the narrowed section of your urethra or enlarging it. The procedure might also involve reconstruction of the surrounding tissues. Tissues from other areas of the body, such as your skin or mouth, may be used as a graft during reconstruction. The recurrence of urethral stricture after a urethroplasty is low.
- Endoscopic urethrotomy. For this procedure, your doctor inserts a thin optical device (cystoscope) into your urethra, then inserts instruments through the cystoscope to remove the stricture or vaporize it with a laser. This surgical procedure offers a faster recovery, minimal scarring and less risk of infection, although recurrence is possible.
- Implanted stent or permanent catheter. If you have a severe stricture and choose not to have surgery, you may opt for a permanent artificial tube (stent) to keep the urethra open, or a permanent catheter to drain the bladder. However, these procedures have several disadvantages, including a risk of bladder irritation, discomfort and urinary tract infections. They also require close monitoring. Urethral stents are often a measure of last resort and are rarely used.
Generally, whenever urethroplasty is possible for treating urethral stricture, doctors prefer that procedure over other surgical treatments. The conventional wisdom is that performing urethroplasty early during the course of treatment spares you from needing multiple endoscopic urethrotomies, if urethral stricture recurs.