Urethral Strictures
If you experience unusual urinary symptoms or have difficulty urinating, you may have a urethral stricture.
The urethra is the tube that carries urine from the bladder to the tip of the penis. It runs through the prostate gland and the bottom of the penis. It is like a long tubular donut with the urine running in the middle of the donut where the hole is and the spongy part of the donut called the urethral sponge. When the urethral lining forms a scar and the hole becomes narrow, making it difficult for urine to pass through, we call it a urethral stricture.
A urethral stricture can cause a very slow urinary stream or make it difficult to completely empty your bladder. It may feel like you have to urinate again right after a trip to the bathroom, or a frequent or urgent need to urinate. This condition may also cause pain, bleeding, and a fear of urinating. Over time, a urethral stricture can cause permanent bladder damage, recurrent urinary tract infections (UTIs), blood in the urine, backup of urine in the kidneys, or kidney damage.
Causes
Often, a urethral stricture results from trauma either from an injury such as a car or bike accident or complications from a medical procedure such as a urethral catheter placement, radiation treatment, or prostate surgery. Occasionally, an infection of the urethra or gonorrhea (a sexually transmitted disease) can cause a urethral stricture.
Diagnosis
To test for a urethral stricture, we might perform a physical exam or one of these diagnostic tests:
- Imaging test with X-rays called a retrograde urethrogram (with contrast dye) to assess the length of the stricture and density of the stricture
- Urine flow test and ultrasound to see how the urine flow is affected by the urethral stricture
- UItrasound to determine if you have more than usual urine left in your bladder after urination
- Cystoscopy, where we gently insert a small, bendable, lubricated fiberoptic scope into your urethra under local anesthesia to see the location and appearance of the stricture
Treatment Options
There are several treatment options for a urethral stricture, depending on how large the blockage is and how much scar tissue you have.
Treatment options for a urethral stricture include:
- Active surveillance, which means closely monitoring the stricture
- Dilating or stretching the stricture to treat the symptoms
- Urethrotomy, or cutting the stricture through a scope
- Urethroplasty, or surgical reconstruction of the urethra; which is often the most effective approach
If you have a light, filmy, short stricture without a lot of scar tissue in the urethral sponge (called spongiofibrosis), we often chose to treat with active surveillance, urethral dilation, or an endoscopic incision of the urethra, rather than a surgical procedure.
If, on the other hand, you have a recurrent stricture or a dense or long stricture, we are more likely to perform a urethroplasty. We perform a urethroplasty in the hospital, under general anesthesia. This delicate procedure generally fixes the urethral stricture as well as any spongiofibrosis. Most of the time, it is a permanent cure. We perform a urethroplasty by removing the part of the urethra with the stricture and scar tissue. If it is a long stricture, we may also add new tissue, such as a graft from the mouth (a buccal mucosal graft) or a flap of skin to help reshape urethra.
After the surgery, you may stay in the hospital for a day or two and have a urinary catheter in for two or three weeks. Most people experience dramatic and long-lasting improvement in urinary symptoms. If you have a lot of scar tissue, it is possible that the stricture may recur.
Each stricture is unique in its length and appearance and each patient is also unique with different needs and circumstances. Because of this we individualize stricture treatment using our extensive experience to make sure you will have the best outcome.
Female Urethral Strictures
Although less common, women can also have urethral strictures and our urologists are internationally recognized as experts in treating this problem. The cause and treatments of female urethral strictures are different from men but for women the urethral scar tissue can also cause bothersome urinary problems such as urinary urgency and frequency, slow stream, needing to push to urinate as well as urinary tract infection, pain, and bleeding.
Typically the scar tissue in the female urethra can be treated with dilation of the urethra or cutting the urethral stricture through a small scope inserted in the urethra. We are one of the few centers in the United States that can offer additional treatments for refractory urethral strictures and often see women with urethral strictures in whom these treatment options have failed. For these recurrent strictures, local skin from around the vagina can be used to reconstruct the urethra. We have had significant success using grafts from the inside of the mouth (buccal mucosal grafts) to repair more complicated strictures.