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Urethral Stricture

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Overview

A urethral stricture is the narrowing of the urethra, resulting in reduced flow of urine out of the bladder. In some people, they may not be clinically apparent in initial stages, but as the stricture narrows further, symptoms arise.

Pathophysiology

Damage to the urethra can lead to inflammation and the formation of fibrous tissue that is less compliant and susceptible to stretching and tearing when urine pressure builds up. This leads to further inflammation and more fibrous tissue forming and results in a cycle.

Epidemiology

  • The prevalence of urethral stricture is around 200 per 100,000 men in their 20s
    • This increases to 900 per 100,000 men in their 70s

Causes

  • Idiopathic – around 1/3 of cases
  • Iatrogenic – around 1/3 of cases
    • Examples are procedures involving the urethra such as transurethral procedures and prolonged catheterisation
  • Sexually transmitted infection – commonly gonorrhoea
  • Recurrent urinary tract infections (UTIs)
  • Lichen sclerosus – inflammation can lead to stricture formation
  • Trauma – pelvic fractures, penile fracture

Presentation

Overview

Features of urethral strictures are predominantly voiding symptoms. These vary depending on the severity of the stricture and the presence of any co-existing urological disorders:

  • Decreased urinary stream
  • Feeling of incomplete emptying
  • Straining when passing urine

Other features are less common and may include:

Investigations

Overview

Investigations may include:

  • Residual urine assessment:
    • The patient urinates and residual volume is measured via ultrasound
  • Uroflowmetry:
    • Involves passing urine into a special toilet with a device present that measures the volume and rate of urine released
  • Urethroscopy:
    • May identify stricture directly, but may not be possible as the urethroscope tube may not be able to pass through the stricture
  • Urethrography:
    • A radiographic study using contrast media, may identify stricture

Management

Overview

Management generally involves transurethral procedures such as dilation or endoscopic urethrotomy. In some cases, open surgery and procedures such as stricture resection or urethroplasty may be necessary.

Complications

  • Recurrent UTI
  • Acute urinary retention
  • Bladder diverticulum
  • Vesicoureteric reflux

Prognosis

  • Urethral strictures have a high recurrence rate if managed non-surgically
  • If surgically managed, success rates are as high as 85%

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