The urethra has the job of allowing urine from the bladder to pass out of the body in both men and women.  In men, this thin tube also has the important role of allowing ejaculation or semen to pass from a man’s body.

Urethral strictures refer to any narrowing of the urethra for any reason whether or not it actually impacts the flow of urine out of the bladder.  A urethral stricture is not going to be a common topic among women as they are much more common among men and boys than women and girls – in fact, urethral strictures are considered rare in women.  The reason why urethral strictures are more common in males is because males have a longer urethra than women – the urethra is about 7-8 inches long in men compared to only 2 inches in women.

What is a urethral stricture

A urethral stricture can occur when scarring narrows the tube carrying urine out of the body, the urethra, resulting in a restriction of the flow of urine from the bladder.  Because of this restriction of the flow of urine out of the body, this problem can result in a number of medical issues involving the urinary tract which can include inflammation or infection.

Causes of urethral strictures

The causes of why a man may develop a urethral stricture can be many.  This buildup of scar tissue that narrow the urethra can be due to the following:

·Tissue damage from a urologic procedure using medical instruments inserted into the urethra.  Sometimes using an endoscope to view urinary tract structures could cause this to happen.

·Intermittent or long-term use of a catheter. Catheters are a tube inserted into the urethra to help drain urine from the bladder into the urethra and out of the body.

·Trauma or direct injury to the urethra or pelvis such as a pelvic fracture.

·Enlarged prostate or previous surgery to remove or reduce an enlarged prostate gland.

·Cancer of the urethra or prostate

·Sexually transmitted infections.

·Congenital urethral strictures can be present at birth in but are considered to be rare

Signs and symptoms of a urethral stricture

·Urine stream will slow down which can happen suddenly or gradually

·Urine leakage or dribbling after urination

·Spraying of the urine stream

·Difficulty, straining or pain when urinating

·Increased urge to urinate or more frequent urination

·Blood or discharge from the penis

·Pain in the pelvis or lower abdomen

Diagnosing urethral strictures

Anyone experiencing any of the signs or symptoms of a urethral stricture or noticing any changes in bladder habits, should contact their primary care physician as soon as possible.  A referral to a urologist would be advisable as they can do a thorough physical exam along with asking about other pertinent medical history.  There are also a number of tests that can be used to determine the diagnosis which could include the following:

·Urinalysis – this looks for signs of infection or blood in the urine

·Urinary flow test – this test will measure the strength and amount of urine flow

·Urethral ultrasound – this test will evaluate the length of the stricture

·Pelvic ultrasound – this will look for the presence of urine in your bladder after urination

·Pelvic magnetic resonance imaging (MRI) – this test will assess whether the pelvic bone is affecting or is affected by the condition

·Retrograde urethrogram – this uses x-ray images to check for a structural problem or injury of the urethra.  It can also assess the length and location of the stricture along the urethra

·Cystoscopy – this test will examine the urethra and bladder using a device called a cystoscope to view the urethra and bladder. 

Treatment

There can be many options to treat a urethra stricture depending on the size of the blockage and how much scar tissue is involved. 

The treatments could include the following:

·Dilation – this involves enlarging the structure with gradual stretching

·Urethrotomy – this involves cutting the structure with a laser or knife through a scope

·Open surgery – this is a surgical removal of the stricture with reconnection and reconstruction, possibly with grafts

At this time, there are no medications that can be used to treat a urethral stricture. 

If a person with a urethral stricture is not treated, they can continue to have problems with passing urine.  This could lead to urinary and/or testicular infections and stones could develop.  There is also the possibility of a risk of urinary retention or the inability to pass urine leading to an enlarged bladder and kidney problems.

Preventing urethral strictures

While prevention of a urethral stricture may not always be possible, there are certain steps one can do to minimize this from happening:

·Avoid injury to the urethra and pelvis

·If you self-catheterize, avoid problems by using a lubricating jelly liberally and use the smallest possible catheter needed for the shortest duration of time

·Avoid sexually transmitted infections (STI).  At one time gonorrhea was the most common cause of strictures but now chlamydia is a more common cause of this condition.  Always use a condom as STIs can be prevented by their use and avoid sex with infected partners.  Get treated right away with antibiotics if diagnosed with a STI.