What is urethral stricture?
The urethra is an organ of the urinary tract that carries urine from the bladder and releases it from the body. The urethra tube is generally wide enough for the urine to flow easily through it. However, when the urethra tube becomes contracted, it restricts the urinary flow. This condition is called the urethral stricture. Urethral stricture is a medical condition that occurs more frequently in men than in women because of their anatomical characteristics.
What are the causes of urethral stricture?
A urethral stricture occurs due to the presence of scar tissue or tissue inflammation. Scar tissue is a result of many factors. Young boys who had a procedure to correct an underdeveloped urethra and men who had penile implants have a higher chance of developing urethral stricture.
A straddle injury is a common type of trauma that leading to urethral stricture. Examples of straddle injuries include falling on a bicycle bar or being hit in the area close to the scrotum.
Other possible causes of urethral stricture include:
- Benign Prostatic Hyperplasia (BHP)
- Prostate surgery
- Catheter insertion
- Pelvic fractures
Rare causes include:
- A tumor located close to the urethra
- Untreated or repetitive urinary tract infections
- The sexually transmitted infections (STIs)
Some men can develop a urethral stricture, due to:
- An enlarged prostate
- Swelling and irritation in the urethra caused by infection
- A recent catheter inserted into the body to drain urine from the bladder
What are the symptoms of urethral stricture?
Symptoms of Urethral stricture can range from mild to severe. Some signs which indicate that you may have a urethral stricture are:
- Frequent and sudden urge to urinate
- Reduction in the volume of urine or weak urine flow
- Feeling the bladder is still full even after urination
- Frequent stopping and starting of the urine stream
- Burning sensation or pain while urinating
- Inability to control urination or lack of control over urination
- Pain in the lower abdominal area
- Urethral discharge
- Penile pain and swelling
- Presence of blood in urine or semen
- Darker urine colour
- Unable to urinate (Note: this requires immediate medical attention)
Diagnosis of Urethral Stricture:
Your physician may use several approaches to diagnose urethral stricture, such as:
- Reviewing your medical history and symptoms
- Physical examination of the penis area i.e possibly looking for urethral discharge (redness)
- Conducting several tests and measuring the urine rate of flow
- Blood and urine test
- Tests for gonorrhea and chlamydia
What are the treatment options for urethral stricture?
Treatment depends on the severity of the condition.
- Nonsurgical: The doctor will use a medical instrument known as the dilator to make the urethra wider. This is performed by inserting a wire into the urethra. Another non-surgical treatment option could be a permanent urinary catheter placement. This has side effects because it causes urinary tract infections and bladder irritation.
- Surgery: Open urethroplasty is a common surgical option for doctors to treat urethral strictures. This procedure involves removing the contracted tissue and reconstructing the urethra and the results will vary based on the stricture size.
- Urine Flow Diversion: This surgery will permanently reroute the flow of urine to an opening in the abdomen. It involves using part of the intestines to help in connecting the ureters to the opening. Urinary diversion is generally performed if the bladder is severely damaged or if it needs to be removed.
What are the surgery options for urethral stricture?
The surgery takes about 2 to 4 hours. You and your doctor should discuss the options.
- For laparoscopy, the surgeon will make several small incisions in the abdomen. The scope is inserted through one of the small incisions and it sends pictures from the abdomen to a video screen. Surgical tools are inserted through the other incisions. The surgeon might use a technique called robotic laparoscopy. This robotic system gives a 3-D view inside the body and also assists the surgeon’s hand movements.
- For open surgery, one large incision will be made in the side over the ribs, or in the abdomen. The surgeon views and works through the incision and performs the operation (urethroplasty) as mentioned below.
How is urethroplasty performed?
Step 1 – In case a large section of the ureter is removed, then the cut ends of the ureter are stitched together. These stitches will dissolve over time.
Step 2 – A long, flexible tube called a stent is inserted in the ureter. The stent is kept in place for 4 to 6 weeks after surgery, to hold the ureter open while it heals.
Step 3 – After the surgery, all the tools are removed and the incisions are closed with sutures, staples, surgical glue, or strips of surgical tape.
What happens after urethroplasty?
- After the surgery, you may feel sleepy and nauseated.
- The catheter in your urethra and any drains will be removed before you go home. If not, you will be instructed how to care for them at home.
- After the surgery, you will require follow-up visits with your surgeon. If sutures or staples need to be removed, then this is done within 1 to 2 weeks after the surgery.
- The stent in the ureter will be removed within 4 to 6 weeks. About 3 months after surgery, you may need to have an imaging test. This will check that the ureter is open and the kidney is functioning properly.
What are the complications of urethroplasty?
Risks and possible complications include:
- Bleeding (may require a blood transfusion)
- Urine leakage from the ureter or bladder
- Stricture returning after surgery
- Kidney damage
- Blood clots
- Side effects of anesthesia
If not treated at an early stage, this could lead to severe complications which include the following:
- The formation of a malignant tumor (cancer)
- Urinary tract infections and bladder stones
- Complete blockage of urine flow
What is the outcome and recovery for urethroplasty?
Recovery time may vary from person to person and your surgeon will let you know when you can return to your normal routine. Until then, follow the instructions you have been given and make sure to:
- Take all medicine as directed.
- Follow your surgeon’s guideline for showering and you need to avoid swimming, using a hot tub, and other activities that cause the incision to be covered with water until your surgeon’s instruction.
- Avoid lifting heavy objects and refrain from strenuous activity.
- Do not drive until your surgeon’s instruction.
- Avoid straining during a bowel movement. If needed, take stool softeners as directed by your physician.
Note: Due to the stent in your ureter, you will have the urge to pass urine more often. You may also have some burning sensation and blood in your urine. This is normal and will go away when the stent is removed during a follow-up visit.
How can you Prevent Urethral Stricture?
It’s not always possible to prevent urethral stricture. Since STIs are one cause, using protection during sexual contact will prevent some cases. However, injuries associated with urethral stricture cannot always be avoided.
It is important to see a physician right away if you’re experiencing symptoms of urethral stricture. Treating the problem as soon as possible is the best way to avoid serious complications.
Frequently Asked Question:
How serious is urethral stricture?
If left untreated, a urethral stricture will cause serious problems, including bladder and kidney damage, obstruction of urine flow, and infertility in men.
What causes female urethral stricture?
One reason could be external trauma to the urethra usually from hitting the urethra hard against the pubic bone, or by internal trauma usually after a urological procedure or catheterization.
How do you know if you have a urethral stricture?
Depending on where the stricture is located, patients with strictures will have blockage symptoms including nausea and vomiting, abdominal pain, bloating, or the inability to pass gas and stool.