Urethral Stricture Disease

What is a Urethral Stricture?

A urethral stricture is scar tissue in or around the urethra that can block the flow of urine. Urethral stricture disease can be caused by radiation or chemotherapy from prostate cancer treatment, congenital abnormalities of the urinary tract, neurogenic bladder, ureteropelvic junction (UPJ) obstruction, or inflammation, injury or infection of the urethra. Urethral strictures are more common in men.

Causes of Urethral Stricture Disease

Injury and infection to the urethra are two of the most common causes of urethral stricture disease in men. For example, bicycle straddle injury is a common cause of urinary problems in men. Trauma such prostate surgery or treatments, removal of kidney stones, and urinary catheterization are also common causes of urethral strictures in men. 

Symptoms of Urethral Strictures

The following symptoms may be a sign of urethral strictures:

  • Slow urine stream or decrease in urination
  • Painful urination
  • Spraying of the urine stream
  • Hematuria or blood in the urine
  • Abdominal pain
  • Urinary tract infection

It's important to note that these are common symptoms for other medical conditions and should be brought to the attention of your doctor for a full evaluation to determine the cause. 

 

Diagnosing Urethral Stricture Disease

Your doctor will first perform a complete physical exam as well as recommened and perform a urethral imaging study such as X-ray or ultrasound of the urethra. Other tests may include:

  • Retrograde Urethrogram - This test allows the urologist to visualize any structural abnormalities in the urethra including narrowed areas or blockages. This imaging study is done in the office and typically takes only a few minutes. Your doctor will inject a dye into the urethra and x-rays are taken to view the entire urethra. 
  • Urethroscopy - A small, flexible telescope is placed into the urethra. Thi study allows your doctor to see inside the urethra from the tip of the penis to the location of the stricture. 

 

Treatment for Urethral Strictures

For patients with urethral stricture disease, urethroplasty is often the treatment of choice. Urethroplasty is a surgical procedure most often performed by a reconstructive urologist that repairs the scarred urethra to restore normal urine flow.

  • Buccal graft urethroplasty is a procedure where the reconstructive urologist will take tissue from the skin lining inside of the mouth and transfer or graft the tissue to the urethra to create an open pathway for urine.

 

Surgical Procedures for Ureteral Injury and Congenital Conditions

In addition to urethroplasty for stricture disease, Dr. Andrew Chang, Chesapeake Urology's reconstructive urologist, performs reconstructive surgery for patients who experience ureteral injuries as well as congenital conditions including:

  • Boari flap and Psoas hitch - For ureteral injuries that are close to the bladder, the reconstructive urologist creates a flap out of the bladder (boari flap) to substitute the segment missing in the ureter, or can perform a psoas hitch, which attaches a portion of the bladder wall to the psoas muscle.
  • Ileal ureteral substitution and transureteroureterostomy (TUU) are urinary diversion techniques that take a segment of the small bowel to replace portions of the ureter damaged by injury. These procedures are typically performed on large defects of the ureter.
  • Laparoscopic pyeloplasty is a surgical procedure performed to correct an obstruction between the kidney and the ureter (the tube that carries urine to the bladder).