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A urethral stricture occurs when scarring causes a narrowing of the tube responsible for carrying urine out of the body, known as the urethra. This narrowing restricts the flow of urine from the bladder and can result in various medical issues within the urinary tract, such as inflammation or infection.
Men who experience a stricture may notice a gradual increase in discomfort during urination and a decrease in the strength of their urinary stream. This progression can lead to the need to exert more effort or strain in order to pass urine. In some cases, the problem may arise suddenly and unexpectedly, requiring immediate medical attention.
Symptoms
Urinary tract stricture symptoms and signs include:
- Feeling of being unable to completely empty the bladder.
- Decreased urine stream
- Pain, discomfort, or difficulty when passing our urine.
- Increasing the need to urinate or urinating more frequently.
- Infection in the urinary tract
Urinary retention, a condition seen in patients with severe urethral strictures, is characterized by the inability to urinate. This condition is considered a medical emergency due to its potential complications. One such complication is hydronephrosis, which occurs when urine backs up into the kidneys due to a poorly draining bladder. If left untreated, urinary retention can lead to renal failure, a serious condition affecting kidney function. Therefore, immediate medical intervention is crucial in these cases to prevent further complications.
Causes
Scar tissue can develop as a result of various factors, primarily chronic inflammation or injury. The following are the most common causes leading to the formation of scar tissue.
- Medical procedures involving the insertion of instruments, such as endoscopes, into the urethra.
- Prolonged or intermittent use of a catheter, a tube inserted through the urethra to drain the bladder.
- Trauma or injury to the urethra or pelvis.
- Enlarged prostate or previous surgery to treat or reduce an enlarged prostate gland.
- Urethral or prostate cancer.
- Sexually transmitted infections.
- Radiation therapy.
The presence of scar tissue causes the narrowing of the urethra, which in turn makes it more challenging for urine to flow properly. In some cases, the inflammation or injury to the urethra may occur long before the symptoms of stricture become noticeable. Alternatively, the development of a stricture may follow shortly after a urethral injury.
Diagnosis
Non-invasive tests can potentially detect difficulties in bladder emptying, but they are unable to provide a conclusive diagnosis for a stricture. However, it is impossible to tell from non-invasive testing if these problems might be brought on by a stricture, enlarged prostate, weak bladder, or another disease. An imaging method is required to locate and measure a suspected urethral stricture.
- Urinary flowmetry. Urinating into a collecting device allows you to monitor the flow rate of your urine; a blocked urethra or a weak bladder may both contribute to a slow flow during this test.
- Bladder ultrasound. Typically, after urination, the bladder is expected to be completely empty. However, in cases where there is a stricture, a condition characterized by the narrowing of the urinary pathway, it is possible for some urine to remain in the bladder. To determine the amount of urine left in the bladder after urinating, an ultrasound scan specifically focused on the bladder can be performed to measure the post-void residual volume.
- Retrograde urethrogram. This procedure involves the use of an X-ray and a contrast agent that is injected into the opening of the penis. The contrast agent helps to highlight the stricture and its length on the X-ray film.
- Cystoscopy. During this procedure, a slender and flexible camera known as a cystoscope is gently inserted into the urethra, enabling the doctor to visualize the inner lining of the urethra and bladder. The entire process usually lasts between five to 10 minutes. To minimize discomfort, a numbing medication called lidocaine jelly is applied to the urethra before the cystoscope is inserted into the bladder.
Treatment
The appropriate treatment for urethral stricture is determined based on the findings from imaging procedures. There are several options available, including urethral dilation, internal urethrotomy, and urethral reconstruction. For shorter strictures, initial attempts may involve urethral dilation or internal urethrotomy. These procedures are performed under general anesthesia, where the urethra is gradually widened using dilating instruments and a cystoscope. In the case of an internal urethrotomy, a specialized tool is used with the cystoscope to cut the scar tissue ring and open up the blocked area.
After the procedure, a catheter is typically left in the urethra for a few days. While dilation or urethrotomy can sometimes resolve the issue, the most common problem is the recurrence of the stricture. It is normal to experience blood in the urine for a certain period after any procedure involving the urinary tract.
If dilation or urethrotomy is unsuccessful and the stricture returns, a more extensive procedure called urethral reconstruction may be necessary to achieve a lasting solution for opening the urethra. In some situations, the scar tissue is removed and the ends of the urethra are sutured together, which is known as urethroplasty. However, if this is not feasible, alternative methods may involve using the lining from the inside of the cheek or creating skin flaps from the penis or scrotum to rebuild the urethra. These different types of urethroplasty can typically reconstruct the urethra with a high success rate in most cases.
