Urethral stricture

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.