Urethral stricture

Causes of Urethral Stricture

Urethral strictures can be caused by several factors, often resulting from damage to the urethra. The most common causes include:

1. Injury or Trauma:
   • Pelvic fractures: Trauma to the pelvis, such as in car accidents or falls, can cause damage to the urethra.
   • Catheterization: Long-term use of a urinary catheter or a poorly inserted catheter can injure the urethra, leading to scarring.
   • Surgical Procedures: Previous surgeries involving the urethra, bladder, or prostate may result in scarring and the development of a stricture.
2. Infections:
   • Sexually transmitted infections (STIs): Infections like gonorrhea or chlamydia can cause inflammation and scarring of the urethra, leading to strictures.
   • Urinary Tract Infections (UTIs): Chronic or untreated UTIs can cause scarring in the urethra, resulting in narrowing.
   • Prostatitis: Inflammation or infection of the prostate gland can extend to the urethra, causing scarring.
3. Inflammatory Conditions:
   • Lichen sclerosus: A chronic skin condition that can cause scarring in the genital area, including the urethra, leading to strictures.
   • Radiation therapy: Radiation treatment for pelvic cancers can cause damage to the urethra, leading to narrowing over time.
   • Chronic urethritis: Long-term inflammation of the urethra, often due to infections or irritants, can result in scarring.
4. Congenital Factors:
   • Some people are born with a naturally narrow urethra, although this is less common than acquired strictures.
5. Other Factors:
   • Prostate surgery: Procedures like transurethral resection of the prostate (TURP), which is used to treat BPH, can lead to scarring of the urethra.
   • Urinary retention: Chronic difficulty emptying the bladder due to an obstruction can lead to pressure and injury to the urethra.

Symptoms of Urethral Stricture

The symptoms of a urethral stricture depend on the severity and location of the narrowing, but common symptoms include:

• Difficulty urinating: Straining to urinate, weak or interrupted urine stream, or feeling that the bladder is not completely empty.
• Urinary retention: In severe cases, a person may be unable to urinate at all, requiring urgent medical attention.
• Frequent urination: The need to urinate more often, particularly in the night (nocturia).
• Pain or burning during urination (dysuria).
• A feeling of incomplete bladder emptying.
• Dribbling: A slow, weak urine stream that dribbles after the main stream ends.
• Hematuria: Presence of blood in the urine (in more severe cases).
• Urinary tract infections (UTIs): Strictures can increase the risk of UTIs, which may cause fever, discomfort, or cloudy urine.

Diagnosis of Urethral Stricture

The diagnosis of a urethral stricture typically involves several steps, including a detailed medical history, physical examination, and a variety of diagnostic tests:

1. Medical History and Symptom Assessment:
   • The doctor will inquire about symptoms such as difficulty urinating, history of trauma, infections, or previous surgeries.
2. Physical Examination:
   • A physical exam, including a digital rectal exam (DRE) or genital examination, may be performed to assess the external genitalia and rule out other potential causes.
3. Urethroscopy (Cystoscopy):
   • A small camera (cystoscope) is inserted through the urethra to directly visualize the narrowing and assess the severity and location of the stricture. This is the gold standard for diagnosing urethral strictures.
4. Uroflowmetry:
   • A test to measure the rate and volume of urine flow. A reduced urine flow rate can suggest the presence of an obstruction, such as a stricture.
5. Retrograde Urethrogram:
   • A contrast dye is injected into the urethra, and X-rays are taken to provide a detailed image of the urethra and identify any narrowing or blockage.
6. Voiding Cystourethrogram (VCUG):
   • This test is similar to a retrograde urethrogram but involves imaging the bladder as well, which helps evaluate the urethra during urination.
7. Ultrasound:
   • In some cases, an ultrasound may be used to visualize the urinary tract and kidneys to rule out other conditions, such as bladder or kidney damage, resulting from prolonged obstruction.

Treatment of Urethral Stricture

Treatment options for urethral strictures depend on the severity, location, and symptoms, as well as whether there are any underlying causes (such as infections or trauma). Treatments may include conservative management, endoscopic procedures, and surgery.

1. Non-Surgical Treatments (Conservative Management)

• Dilation: In some cases, the urethra can be gradually dilated using a series of increasingly larger catheters or balloons. This procedure can provide temporary relief but may need to be repeated if the stricture recurs.
• Self-Catheterization: In cases of chronic stricture, patients may be advised to use intermittent catheterization (inserting a catheter into the urethra to drain urine). This helps manage urinary retention and prevent infections.

2. Endoscopic Procedures

• Urethrotomy: This is a procedure in which a small incision is made in the stricture to relieve the narrowing. This can be done using a cystoscope (a camera inserted into the urethra). Urethrotomy is effective for short and uncomplicated strictures, but there is a risk of recurrence.
• Dilation with Balloon: A balloon catheter can be inserted into the stricture and inflated to stretch and open the narrowed area. This may be used for relatively mild strictures, but like urethrotomy, it may require repeat treatments.

3. Surgical Treatments

For more severe or recurrent strictures, surgery may be required. The type of surgery depends on the location, length, and severity of the stricture.

• Urethroplasty: The most definitive surgical treatment for urethral stricture. In this procedure, the narrowed portion of the urethra is either removed or opened up, and the remaining healthy tissue is reconnected. Urethroplasty has a high success rate, especially for long or complex strictures. There are different approaches to urethroplasty depending on the location of the stricture:
  • Anastomotic urethroplasty: In this procedure, the strictured portion of the urethra is removed, and the remaining healthy ends of the urethra are reconnected.
  • Graft Urethroplasty: When the stricture is long and cannot be directly repaired, a graft of tissue (often taken from the cheek, thigh, or bladder) is used to reconstruct the urethra.
• Penile Urethroplasty: This surgery is performed for strictures located in the penile portion of the urethra. It involves removing the narrowed segment and reassembling the urethra.
• Excision and Primary Anastomosis: If the stricture is localized and the urethra can be easily reconnected, the stricture is excised, and the two ends of the urethra are surgically rejoined.

4. Treatment of Underlying Causes

If the stricture is caused by an underlying infection, inflammatory condition, or other factors, addressing the root cause is important. This may include:

• Antibiotics: For infections like sexually transmitted infections (STIs) or chronic urethritis, antibiotics may be prescribed.
• Steroids or Immunosuppressive Drugs: If the stricture is due to an autoimmune condition like lichen sclerosus, topical steroids or other immunosuppressive medications may help manage the disease and prevent further scarring.

Prevention of Urethral Stricture

While not all urethral strictures can be prevented, certain measures can help reduce the risk of developing one:

1. Proper Catheter Use: If a catheter is necessary, ensuring it is properly inserted and maintained can help prevent injury to the urethra.
2. Timely Treatment of Infections: Prompt and adequate treatment of urinary tract infections (UTIs) or sexually transmitted infections (STIs) can prevent scarring of the urethra.
3. Avoiding Trauma: Minimizing the risk of injury to the pelvic region (such as from accidents or physical activities) can help prevent urethral damage.
4. Regular Monitoring: Men who have had previous urethral surgeries or injuries should have regular check-ups to monitor for any signs of recurrent strictures.

Conclusion

Urethral stricture is a condition that can cause significant urinary problems due to the narrowing of the urethra. Treatment options range from non-invasive procedures, such as urethrotomy or dilation, to more advanced surgical approaches like urethroplasty. Early diagnosis and appropriate management are key to preventing complications such as urinary retention, infections, and kidney damage. If you experience symptoms like difficulty urinating, painful urination, or frequent UTIs, it is important to consult a healthcare provider for evaluation and treatment.