A stricture occurs when a part of your urethra (the tube that carries urine) becomes narrowed. Any section of your urethra may be affected, from the bladder to the tip of the penis. There is usually some scar tissue around the affected part of your urethra that causes the narrowing.
The length of strictures vary from less than 1 cm to the full length of the urethra. The diagram below illustrates a fairly long and severe stricture. However, many are shorter than this. Urethral stricture is uncommon in men and rare in women.
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Urethral stricture symptoms
There may not be any symptoms initially. However, the following symptoms of urethral stricture - which are likely to worsen with time - may occur:
- Reduced urine flow is the usual first symptom. Straining to pass urine is common but a complete blockage of urine flow is rare.
- Spraying of urine or a double stream may occur.
- Dribbling of urine for a while after going to the toilet to pass urine.
- Frequency sometimes occurs (needing to pass urine more often than normal).
- Urinary tract infections (UTIs).
- You may have a reduced force of ejaculation.
- Sometimes, pain on passing urine.
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Urethral stricture causes
- Injury or damage to the urethra can heal with scar tissue that may cause a stricture. There are various types of injury that can damage the urethra. For example: an injury may occur during medical procedures to look into your bladder via your urethra; radiotherapy treatment may damage your urethra; a fall astride on to the frame of a bike can cause damage, or any trauma which is severe enough to cause a pelvic fracture.
- Infection of your urethra is another cause - for example:
- Sexually transmitted infections such as gonorrhoea or chlamydia.
- Infection as a complication of long-term use of a tube (catheter) to drain your bladder.
- Infection may cause inflammation in the tissues in and around your urethra.
- These infections usually clear with treatment but may leave some scar tissue at the site of the inflammation, which can cause a stricture. Note that most urethral infections do not cause a stricture. A stricture is just one possible complication from a urethral infection.
- Some babies are born with a urethral stricture.
- Cancer - very rarely, a cancer of the urethra can be the cause of a stricture.
Complications of urethral stricture
More pressure is needed from the bladder muscle to pass urine out through a stricture (it acts like a bottleneck). Not all urine in the bladder may be passed when you go to the toilet. Some urine may pool in the bladder. This residual pool of urine is more likely to become infected.
This makes you more prone to bladder, prostate and kidney infections. A ball of infection (an abscess) above the stricture may also develop. This can cause further damage to the urethra and tissues below the bladder. Cancer of the urethra is an extremely rare complication of a long-standing stricture.
Urethral stricture diagnosis
Are tests needed?
As with all medical conditions, your doctor will start by asking you what your symptoms are (taking a history) and will then move on to a physical examination.
Tests to determine the flow rate of urine are usually advised if a urethral stricture is suspected. These are generally done by hospital consultants, after referral by a GP.
- Passing urine and measuring how much is passed per second. The flow rate is much reduced if you have a stricture.
- A look into the urethra by a special thin telescope called a cystoscope will be needed to assess the stricture.
- Special X-rays may be taken whilst you pass urine, which can show the site and severity of a stricture. This is called a retrograde urethrogram and involves having a contrast dye put into the bladder via a catheter, and x-rays are then taken to look at the flow of the dye out of the bladder, through the urethra.
Treatment for urethral stricture include:
- Widening of the stricture.
Treatment is usually advised to improve the flow rate of urine, to ease symptoms and to prevent possible complications. A specialist surgeon called a urologist advises on treatment. (A urologist treats problems of the urinary tract - such as conditions affecting the prostate, bladder, kidney and penis.) The one advised by your specialist will depend on factors such as the site and length of your stricture and also your age and general well-being.
Widening (dilatation) of the stricture
This is usually done by passing a thin plastic rod (boogie) into the urethra. This procedure may be done either under a local or a general anaesthetic. Rods of increasing thickness are gently inserted to gradually dilate the narrowed stricture. The aim is to stretch and widen the stricture without causing additional scarring.
However, a stricture often tends gradually to narrow again after each dilation. Therefore, a repeat dilation is commonly needed every so often when symptoms recur. (Some people are given a self-lubricating tube (catheter) which they insert themselves regularly to keep a stricture dilated.)
As a rule, the shorter the stricture, the greater the chance of a cure with dilation. It is a relatively easy procedure to do and so may be tried first.
In this procedure, a thin telescope is passed into the urethra to see exactly where the stricture is. This is done during a general anaesthetic. A tiny knife is then passed down the telescope to cut along the stricture. This widens the narrowed stricture.
You will get relief of symptoms from this procedure. About half of people are cured for good by this procedure. However, like dilation, the stricture may re-form and the procedure may have to be repeated from time to time in some cases.
Generally, the shorter the stricture, the greater the chance of a cure with this procedure.
A corrective operation which is called a urethroplasty is performed if the above procedures do not work. Various techniques are used. For example, a short stricture can be cut out and the two ends of the healthy urethra stitched together.
If the stricture is longer then one kind of operation is similar to skin grafting the inside lining of the urethra. A graft is usually used from the inside of your cheek to form the new section of your urethra.
Techniques continue to improve and your specialist will advise if an operation is likely to be successful and which operation is best for the length and site of your stricture. As a rule, there is a high success rate in curing symptoms with these operations.
A long course of antibiotics may be advised to prevent urine infections until a stricture has been widened.
Urethral stricture prevention
It may not always be possible to prevent a stricture, but the list of causes gives us some obvious ways to reduce the chance of getting one. Using condoms whenever you have sex will reduce the risk of getting a sexually transmitted infection, which is a risk factor for urethral stricture. Taking sensible safety precautions to avoid pelvic trauma could also reduce the risk.
The outlook will vary depending on the cause and the severity of the stricture - your urologist will be able to give you a better idea of your own personal outlook (prognosis) if you have a urethral stricture.
Further reading and references
Lee YJ, Kim SW; Current management of urethral stricture. Korean J Urol. 2013 Sep54(9):561-9. doi: 10.4111/kju.2013.54.9.561. Epub 2013 Sep 10.
Tritschler S, Roosen A, Fullhase C, et al; Urethral stricture: etiology, investigation and treatments. Dtsch Arztebl Int. 2013 Mar110(13):220-6. doi: 10.3238/arztebl.2013.0220. Epub 2013 Mar 29.
Hampson LA, McAninch JW, Breyer BN; Male urethral strictures and their management. Nat Rev Urol. 2014 Jan11(1):43-50. doi: 10.1038/nrurol.2013.275. Epub 2013 Dec 17.
Jackson MJ, Veeratterapillay R, Harding CK, et al; Intermittent self-dilatation for urethral stricture disease in males. Cochrane Database Syst Rev. 2014 Dec 1912:CD010258. doi: 10.1002/14651858.CD010258.pub2.
Lumen N, Hoebeke P, Willemsen P, et al; Etiology of Urethral Stricture Disease in the 21st Century. J Urol. 2009 Jul 17.