Urethral Stricture Disease: Causes, Symptoms & Treatment

The urethra is a tube that carries urine from the urinary bladder outside the body. A urethral stricture occurs when this tube becomes narrow due to scar tissue formation within it. Urethral stricture is more common in males. This condition can cause infection and inflammation in the urinary tract. If left untreated, urethral strictures can lead to complications such as kidney and bladder damage, infections, infertility, and ejaculation problems in men. Let’s understand more about urethral stricture.

Urethral stricture can lead to numerous mild to severe symptoms.

• A feeling of a non-empty bladder even after urination
• Increased urge and frequency to urinate
• Pain/burning when urinating
• Decreased/spraying urine stream
• Bladder incontinence (loss of bladder control)
• Urinary tract infections (UTIs)
• Penile pain and swelling
• Darkening of urine
• Blood in urine or semen
• Inability to urinate (this is serious and requires immediate medical help) 

In urethral stricture, constriction of the urethra occurs due to scar tissue or tissue inflammation. The scar tissue which is responsible for narrowing the urethra can be due to the following reasons:

• Radiation therapy
• STIs or sexually transmitted infections
• Cancer of the urethra/prostate
• Injury/trauma to pelvis or urethra
• Enlarged prostate or some previous surgery for the removal/reduction of an enlarged prostate gland
• Some medical procedures that involved the insertion of an instrument (like an endoscope) into your urethra
• Long-term use of a tube (catheter) inserted through the urethra for draining the bladder
• Though rare, repetitive/untreated UTIs can also lead to urethral stricture.

The following approaches may be used for diagnosis:

Medical history 

The doctor will record your medical history, which will include your symptoms, other ailments, and current medications and supplements, if any.

Physical exam

Your doctor will perform a thorough physical examination to look at the physical signs of urethral stricture

Other Tests

Certain tests are done for a definite diagnosis of urethral stricture. They help determine the location, cause, and length of the stricture. The tests are:

• Urethral imaging (X-rays or ultrasound): This is done to evaluate the length of the urethral structure.
• Urethroscopy (to see the inside of the urethra): A small, lubricated, and bendable scope/instrument is placed into the urethra and moved up to the stricture to see the narrowed area.
• Retrograde urethrogram: X-ray images are used to check for an injury or structural problem of the urethra, along with the location and length of the stricture.

The treatment for urethral stricture disease depends on the severity and location of the stricture. Mild strictures may be treated with medication or minimally invasive procedures, while more severe strictures may require surgery. Some treatment options include:

• Catheterization: A small tube called a catheter is inserted into the bladder to drain urine and treat urine blockage. Antibiotics may also be recommended for the treatment of infection, if present.
• Dilation: A tiny wire is passed through the urethra and into your bladder to dilate it. Over time, larger dilators gradually increase the urethra’s width. It is an outpatient procedure and can be suitable for recurrent urethral strictures.
• Urethroplasty: The narrowed portion of the urethra is removed or enlarged. Surrounding tissues may be reconstructed, where the tissues would be taken from other body areas. Recurrence after urethroplasty is low.
• Endoscopic urethrotomy: A thin optical device (cystoscope) is inserted into the urethra. Then the stricture is removed or vaporized with a laser after the insertion of instruments through the cystoscope. The benefits of this method are fast recovery, less risk of infection, and minimal scarring. Recurrence, however, is possible. 
• Implanted stent or permanent catheter: A permanent artificial tube called a stent should be an option to keep the urethra open when the stricture is severe and surgery is not to be done. You may also opt for a permanent catheter for draining the bladder. However, risks are there and urethral stents are measures of last resort.         

Urethral strictures can reoccur, even after surgical treatment. This may require additional surgical interventions. The Urethroplasty technique is often preferred over other treatment options, as it spares you from the need to undergo endoscopic urethrotomy multiple times if the stricture condition recurs.

There is no sure way to prevent urethral stricture, but there are some measures that can be taken to reduce the risk of developing the condition or its recurrence. Some of these include:

• Drinking plenty of fluids: Drinking enough water and fluids can help flush out bacteria and reduce the risk of infections that can cause urethral stricture.
• Practicing safe sex: Using condoms during sexual intercourse can help prevent sexually transmitted infections that can cause urethral stricture.
• Practicing good hygiene: Keeping the genital area clean and dry can help prevent infections that can cause urethral stricture.
• Seeking prompt treatment for urinary tract infections: Treating urinary tract infections promptly can help prevent them from progressing to urethral stricture.
• Avoiding the use of irritating chemicals: Avoiding the use of irritating chemicals, such as harsh soaps or douches, in the genital area can help reduce the risk of developing urethral stricture.
• Seeking prompt treatment for any symptoms: Seeking prompt medical attention for any symptoms of urethral strictures, such as pain during urination or decreased urine flow, can help prevent complications and minimize damage to the urethra.

It is important to note that some cases of urethral stricture may not be preventable, especially if they are due to factors such as injury, surgery, or radiation therapy. In such cases, early diagnosis and treatment can help minimize the severity of the condition and improve outcomes.

Urethral strictures can be troublesome for both males and females. Treatments for urethral strictures range from watchful waiting to surgery. As they can recur, follow-up appointments are crucial to monitor the condition in case they come back.

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