WHAT Are URETHRAL STRICTUREs?
The urethra is an important part of the urinary tract and primarily serves to empty the bladder of urine in men and women. A urethral stricture is scar tissue in the urethra that can block the flow of urine. Urethral strictures are more common in men because their urethras are longer than in women and are more susceptible to disease or injury. Urethral stricture is usually not a congenital (born with) problem and women rarely develop urethral strictures.
Causes of Urethral Stricture Disease
Urethral stricture disease can be caused by trauma, chronic inflammation from STDs, frequent instrumentations for minimally invasive urologic surgery or radiation for prostate cancer treatment. Not uncommonly, some men present with idiopathic form of urethral stricture disease. For example, bicycle straddle injury can lead to urethral strictures in men. Repeated treatments with instruments for removal of kidney stones, and trauma from difficult urinary catheterization can also cause urethral strictures in men.
Symptoms of Urethral Strictures
The following symptoms may be a sign of urethral strictures:
- Slow urine stream
- Complete inability to urinate
- Painful urination
- Spraying of the urine stream
- Hematuria or blood in the urine
- Abdominal pain
- Recurrent urinary tract infections in men
- Urethral discharge
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 recommend 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. It is very important to document the location and size of the stricture and retrograde urethrogram serves as a road map for the urologist for surgical planning. This is a diagnostics procedure only and does not involve cutting or suturing. 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. This 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
There are several options for treatment of urethral stricture disease. The type of procedure your doctor selects depends upon the length, location and extent of scar tissue associated with the stricture.
Treatment options include:
- Enlarging the narrowing by dilations
- Cutting the stricture through a scope with a knife (urethrotomy)
- Surgical removal (excision) of the diseased segment with reconnection and reconstruction possibly with flaps or grafts (substitution)
Current research shows that dilations and/or urethrotomies are not durable procedures, meaning that failure rates are high for these endoscopic procedures. Many times, strictures will come back with longer lengths and more dense scarring.
Urethroplasty - High Cure Rates, Benefits for Patients
Urethroplasty is the surgical excision (removal) of the urethral stricture. Research also shows that urethroplasty has excellent cure rates. Reconstructive urologists use various techniques including penile skin flaps and extra-genital skin (skin lining inside of the mouth) grafts in urethroplasty.
For patients with recurrent 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.
Meet Chesapeake Urology's Reconstructive Urologist
Andrew Chang, M.D.
Dr. Chang is one of the region's foremost reconstructive urologists. He completed his fellowship training in reconstructive urology and trauma and specializes in male pelvic reconstructive surgery, ureteral injury and ureteral reconstructive surgery, urethral stricture disease and urethral reconstructive surgery.
Read more about Andrew Chang, M.D.