Urethral Stricture

Urethral stricture (narrowing of the urethra) is uncomfortable congenital or acquired condition that affects mainly men. In addition to worsened quality of life, it may be caused by some serious conditions that require medical therapy.

 

Note: Urethral stricture is possible in both sexes, but it is more typical in men. Male urethra is longer than in women and it passes through the prostatic gland. The narrowing can occur in any part.

Causes

The urethra may be narrowed from birth as a congenital defect. Otherwise, the narrowing may occur due to recurrent infections of the urethra (post-inflammatory narrowing), injury, or because of enlarged prostate (including both benign enlargement of prostate and prostate cancer), which compresses the prostatic part of urethra. The injury may be associated with the introduction of urinary catheters or some less common sexual practices associated with insertion of various objects into the urethra. The resultant injury can be followed by inflammation and narrowing. When talking about urethral infections, it is necessary to mention the role of sexually transmitted diseases (e.g. gonorrhea).

Symptoms

Symptoms include pain during urination, interrupted urine flow and a feeling of incomplete urination. The situation may be complicated by accumulation of urine resulting in recurrent urinary infections including possible pyelonephritis. The accumulation of urine due to urethral stricture may even lead to hydronephrosis.

Diagnosis

Patient with urethral suspected stricture should be examined by a urologist. The prostatic tissue in men can be indirectly examined by digital rectal examination. The urinary bladder, the prostate and the prostatic part of urethra may be visible in ultrasound examination. The flow of urine through the urinary tract including the urethra may be evaluated by intravenous urography. This examination consists of intravenous application of special contrast agent that is filtered in kidney and goes through the urinary tract and makes any narrowed area visible by X-ray. More invasive option is the urethroscopy when an endoscopic device (with a camera) is inserted into urethra. It allows the physician to inspect the inside of the urethra on his own eyes.

Treatment

Narrowing of the urethra is treated using a variety of urological procedures. The simplest is called dilation of the urethra, which is performed by special dilating tools inserted into the urethra. The point is that the physicians gradually use increasingly wider and wider dilator to extend the narrowed urethral section. Severe forms of narrowing may be treated surgically when the narrowed part is completely removed and the surrounding endings of urethra are connected. Naturally, it must be emphasized that the expansion or operation can be followed by a new stricture. Benign enlarged prostate is solved by drugs or operated (see relevant article), prostate cancer is preferably treated by surgery. When the urethral stricture can not be cured, permanent urinary catheterization may be the only option (with regular exchange of the catheters).