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Urethral Stricture

  • Male genitourinary system
  • Female pelvic organs

Definition

A urethral stricture is a scar in or around the urethra, which is the tube that drains urine from the bladder. A stricture can block the flow of urine.

What is going on in the body?

Urethral strictures are more common in men. This is because women's urethras are shorter, and the abnormal conditions affecting them tend to cause difficulty holding urine in, rather than narrowing and blockage.
Anything that harms the urethra can cause a stricture. Rarely, a person can be born with urethral strictures. As the opening of the urethra narrows, it is increasingly more difficult for urine to flow through it, and as a result, the bladder may become enlarged and weakened.

Risks

What are the causes and risks of the condition?

The following conditions can lead to urethral strictures:
  • infection. Gonorrhea infection of the urethra used to be the most common cause of urethral strictures. However, the development of effective antibiotics has made this complication rare today. It is unclear if infections from chlamydia and ureaplasma cause strictures.
    • Common urinary tract infections such as bacterial cystitis do not cause strictures. Infection of the prostate, such as acute prostatitis, chronic prostatitis, or non-bacterial prostatitis, or infection of the epididymis, such as acute epididymitis or chronic epididymitis, may be responsible.
  • external injuries, such as a straddle injury. This occurs when a hard object strikes the base of the perineum, such as on a bicycle. Pelvic fractures can also lead to strictures of the urethra.
  • open or endoscopic surgery. Surgical procedures involving the urethra can result in stricture formation. Rarely, insertion of a urinary catheter can cause this problem.

Prevention

What can be done to prevent the condition?

Protecting against sexually transmitted urethral infections, such as gonorrhea, can prevent some urethral strictures.

Diagnosed

How is the condition diagnosed?

Sometimes a stricture is first diagnosed when a healthcare professional is unable to pass a catheter through the urethra. Strictures may also be suspected based on the person's symptoms and medical history.
The diagnosis is confirmed with endoscopy or another test known as retrograde urethrography. This involves injecting a contrast agent into the urethra so that it shows up on an x-ray. After initial diagnosis, the next step is to determine the length and location of the stricture. This can be done with endoscopy, urethral x-ray, or ultrasound.

Long Term Effects

What are the long-term effects of the condition?

Urethral strictures that do not completely block the urethra can limit urine flow. This can lead to urine retention and cause the bladder to enlarge.

Other Risks

What are the risks to others?

Although, urethral strictures are not contagious, the underlying cause may be contagious, such as a sexually transmitted infection.

Treatments

What are the treatments for the condition?

Urethra strictures are often opened up by inserting catheters, with or without balloons on the end, into the urethra. This method is effective in treating short strictures but not as useful for longer ones.
The next step is a procedure called endoscopic internal urethrotomy. This involves cutting open the stricture from the inside using a knife, laser, or electrocautery. It is done through an endoscope. Most of the time this technique works only for short to medium length strictures located in the front of the urethra.
The most effective technique is open surgery to cut out the stricture. The spliced ends of the urethra are then reattached. Sometimes a graft is used to patch the excised segment. For people with severe strictures who choose not to undergo open surgery, permanent catheters or stents can be inserted into the urethra.

Side Effects

What are the side effects of the treatments?

Urinary catheters need to stay in place for a period of time after many procedures. These can cause infection, bladder irritation, and discomfort.

After Treatment

What happens after treatment for the condition?

Strictures are likely to return after dilation with catheters or endoscopic removal. Open surgery to repair the stricture can be complicated by bleeding, infection, reaction to anesthesia, or damage to the penis or other pelvic structures.

Monitor

How is the condition monitored?

A person treated for urethral strictures should have follow-ups for at least one year. This is to watch for recurrence of the stricture. The primary monitoring test used is uroflowmetry, a test which measures the rate of urine flow during urination.

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