What is urethral stricture?
A urethral stricture is an abnormal narrowing of the urethra that slows or blocks the stream of urine exiting the body. The urethra is part of your urinary system, which is also known as the urinary tract. Your urinary tract includes two kidneys, which filter waste products from the bloodstream and produce urine; two ureters, which transport urine from the kidneys to the bladder; the bladder, which stores urine; and the urethra, which eliminates urine from the body.
The urethra connects the bladder to the outside of the body. It ends at the tip of the penis in men and in the area just in front of the vaginal opening in women. The male urethra also transports semen to the outside of the body. In men, the urethra extends from the tip of the penis, through the prostate gland, and up to the urethral sphincter valve.
While urethral stricture can affect people of all ages, it is not a common condition. It is more likely to occur in men than in women due to the differences in anatomy. Typical symptoms of a urethral stricture include an inability to empty the bladder, a sluggish urine stream, blood in the male ejaculate, pain while urinating, and swelling of the penis.
Urethral strictures are caused by inflammation or scar tissue from infection, trauma or injury, surgery to the penis or urinary tract, and less commonly, tumors that grow near the urethra. Urethral strictures can affect any portion of the urethra. They can also range in length depending on the type and severity of the underlying cause. Treatment of a urethral stricture may involve manually dilating or widening the urethra, or surgical procedures to open or reconstruct the urethra.
In some cases, a urethral stricture can lead to potentially serious, even life-threatening complications, such as urine retention, kidney infection, and permanent kidney damage. Seek prompt medical care for changes in urination or urinary symptoms, such as painful urination, frequent urination, or urethral discharge. Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms, including severe flank or abdominal pain, no urine output, bloody urine, severe shortness of breath, or a sudden change in consciousness or alertness. Rapid diagnosis and treatment can help reduce the risk of complications.
What are the symptoms of urethral stricture?
The symptoms of a urethral stricture are similar to those of other diseases affecting the urinary tract, such as an enlarged prostate, polyps, and certain types of cancer. It is important to see your healthcare provider for proper diagnosis of your symptoms. The symptoms of urethral stricture include:
Blood in the male ejaculate
Difficulty controlling the direction of the urine stream in men
Discharge from the urethra
Frequent or urgent need to urinate
Inability to fully empty the bladder
Lower abdominal or pelvic area pain
Sluggish urine stream
Unusual urine color, such as bloody, pink-colored, dark, or tea-colored
Serious symptoms that might indicate a life-threatening condition
A urethral stricture can lead to retention and pooling of urine in the bladder, bladder and kidney infection (pyelonephritis), and other serious complications. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:
What causes urethral stricture?
Urethral strictures are most often caused by inflammation or scar tissue in the urethra. A variety of diseases, disorders and conditions can cause this inflammation or scarring including:
Injury or trauma to the urethra, such as pelvic fractures, straddle injuries, or contact sports injuries
Lichen sclerosus (an inflammatory condition that causes spots and patches on the genital area)
Surgical procedures involving the penis or urethra, including traumatic insertion or removal of urinary catheters
Tumors that grow and press on the urethra
In rare cases, urethral strictures are present at birth as part of a congenital condition.
A number of factors increase the risk of developing infections and injuries that can lead to scarring or inflammation of the urethra, resulting in urethral stricture. Risk factors include:
Frequent bouts of urethritis (inflammation of the urethra)
Multiple sexual partners, which increases the risk of having an STD
Participation in sports without wearing protective gear over the genital area, which can result in a straddle injury. Examples include contact sports, baseball, or biking.
Prolonged or extended urinary catheter use
Scarring following genital piercing
Surgery or instrumentation involving any structures of the lower urinary tract
Reducing your risk of urethral stricture
Not all risk factors for urethral stricture are controllable. However, you may be able to lower your risk of developing urethral stricture and its complications by:
Abstaining from sexual activity or practicing safer sex through a mutually monogamous (only one sexual partner) relationship and by using condoms
Seeking medical care as soon as possible after you experience symptoms of urethral stricture
Wearing appropriate protective equipment, such as athletic cups over the genitals, when participating in sports
How is urethral stricture treated?
The goal of treating urethral stricture is to permanently cure the condition. This is most often accomplished through surgical procedures to widen, open or reconstruct the urethra. Your treatment and surgical options will vary based on the location and length of the stricture, the type and severity of the underlying cause, and other factors. Your healthcare provider is best able to properly guide your treatment decisions based on your specific circumstances.
Surgical treatments of urethral stricture
Appendicovesicostomy (Mitrofanoff procedure) is a urinary diversion procedure that allows you to drain urine through a catheter in your abdominal wall. Generally, this procedure is used in cases of irreparable damage to the urethra.
Internal urethrotomy is the excision of the stricture to make the opening larger. This is an option for small strictures; however, the recurrence rate is high because the scar tissue is not removed.
Open surgical urethroplasty is scar removal and reconstruction surgery. This is the gold standard treatment for urethral strictures because it has a high success rate.
Suprapubic catheters that drain urine out of the abdomen instead of the urethra are used in emergency situations involving urinary retention.
Urethral dilation, or widening by inserting a dilating device into the urethra, is usually reserved for people who are not candidates for surgery. Dilation is generally a temporary treatment and not a cure.
Other treatments of urethral stricture
Complications of urethral stricture can be serious and life threatening. Urinary retention can occur if your body cannot effectively eliminate urine. This results in urine pooling in your bladder, which encourages bacterial growth and also leads to extreme bladder distention. Following the treatment plan you and your healthcare provider develop specifically for you will minimize the risk of complications including:
Adverse effects of treatment
Bladder infection, bladder stones, and cystitis
Cancer of the urethra
Permanent bladder and urethra damage
Permanent kidney damage, loss of normal kidney function, and kidney failure
Recurrence of stricture formation
Spread of infection and sepsis