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Article on "Urethral Stricture"  

Urethral Stricture

Summary

A Urethral Stricture is when any part of the urethra becomes narrow. Urethral narrowing results in reduced flow of urine or urinary problems. It can be any part of the urethra.

Kidney forms urine by filtering waste products and excess fluid from the blood. After coming out of kidneys, the urine gets stored in a bag-like structure that is present in the lower part of the abdomen. The bag-like structure is known as the urinary bladder. Urethra is a thin tube attached to the bladder. The flow of urine from bladder to urethra is controlled by valves. These valves open up whenever a person wants to pass urine. Urethra opens at the tip of the penis in males and just above the vagina in females. The urine, through urethra, flows outside the body. The urethra is longer in males than in females. This is because in males, it passes through the full length of penis and then opens up at the tip of the penis.

The stricture of the narrowing in the urethra usually happens becomes of scar tissue that may form on the walls of the urethra. This can happen after an injury or an infection.

Urethral Stricture may occur at any age and is more common in men. This is probably due to the longer length of the urethra in males.

Quick Points About the Disease/Condition

Chronic condition because the stricture develops slowly and remains for a long time. can be present from birth, can develop due to infection, can develop after an injury, non-contagious.

Your Body Part or System That it Affects

Urethra, bladder and kidneys may be affected. There may be difficulty in passing urine.

Causes of Urethral Stricture

Normal urethra is wide enough to allow free flow of urine. If the urethra becomes narrow at a point, it puts stress on the flow of urine. The narrowing usually happens due to urethral damage caused by accumulation of immune cells. This process of accumulation of immune cells, accompanied with swelling, is called as Inflammation. Long term inflammation results in formation of scar tissue. Scar tissue deposits on the walls of the urethra and narrows the opening.

Urethral Stricture may form due to the following causes:

  • Injury: Any injury to the urethra results in inflammation. Long term inflammation may result in stricture.
  • Injury to the urethra may occur during medical procedures such as cystoscopy. Cystoscopy is done to diagnose the conditions that affect the bladder or the urethra. In cystoscopy, a thin tube is passed into the urethra to reach the bladder. There is a camera on the tip of the tube, which helps to see the images of the insides of the urethra and the bladder.

  • A blunt injury to the groin region may occur during a road accident. Sometimes, a piercing object may enter the region of the urethra during an accident. All such types of injuries can damage the urethra.

  • Prostate gland is an organ that is present just below the urinary bladder, wrapped around the upper portion of urethra. The prostate gland is a part of reproductive system of males and its secretions form a part of semen. Any surgeries done to remove the prostate gland may result in an injury to the urethra.

  • Radiotherapy is a treatment given for cancer. If it is administered in the region of lower abdomen, it may damage the urethra, resulting in stricture.

  • Infection: Stricture may form after an infection of the urethra. It is more common after infection with Gonococcus or Chlamydia. These microbes are transmitted through sexual intercourse. Sexual transmission is more common in young people as they are often involved in unsafe sexual activities. People who have unprotected sex or sex with multiple partners are more likely to be infected. Also, people who have sex with prostitutes or sex workers carry high risk of infection. Infection is more common in people in whom a catheter is used. A catheter is a thin hollow tube placed into the urethra. The tube is placed to drain urine from the bladder. It may be used when a person undergoes a surgery. People who are not able to control urine flow may also need a catheter.
  • Congenital: Congenital disorders are conditions that are present from birth. Some newborn babies may be born with a narrowing or stricture in the urethra. Stricture probably forms due to abnormal development of the urethra. 

  • Cancer: Cancer of the urethra is rare. But when it occurs, the cancer cells block the opening of urethra, resulting in stricture.

Symptoms of Urethral Stricture

There may be no symptoms for a long time. The symptoms appear only when the narrow part in the urethra starts to block urine, which may worsen with time. The usual symptom, when present, is difficulty in passing urine. The affected person has to strain for passing urine. There may be mild pain while passing urine also. Dribbling of urine may continue for a while after passing urine. The frequency of urine passage may also increase.

Inadequate passage of urine results in accumulation of some urine in the urethra or the bladder. This residual urine is more likely to be infected with microbes. If urinary infection occurs, the affected person may develop high fever, shivering of the body, and a burning sensation while passing urine.

Normal urine flows out of urethra in a single stream. In presence of stricture, there may be double or multiple streams of urine. Also, the force of stream is decreased.

Tests and Diagnosis of Urethral Stricture

The diagnosis starts by verifying the medical history of the person. The doctor may ask about any previous surgery or injury in the region of the urethra. 

Further to that, following tests may be done to confirm the diagnosis:

  • Urine Flow Studies (also known as Uroflowmetry): A urine flow study measures the amount of the urine that is passed by a person in a certain period of time. The person is asked to urinate in a special toilet or into a device that collects the urine. The person is asked not to strain while passing urine. A person who has Urethral Stricture would pass less urine per second or in a certain period of time. Thus the Uroflowmetry helps to diagnose the presence of Urethral Stricture.

  • Ultrasonography: A plastic device is placed over the penis or in the region between penis and anus. The plastic device sends sound waves and receives the reflected sound waves. By processing the reflected sound waves, an image of the urethra and the organs around is created. Thus, Ultrasonography helps to diagnose and assess any narrowing in the urethra.

  • Retrograde Urethrogram: A catheter containing a balloon on its sides is passed into the urethra. The balloon is now inflated with water to block the passage of urethra. A dye is then injected through the catheter. Serial x-rays are taken to determine the position of dye in the urethra. The test helps to accurately determine the location and the extent of stricture.

  • Antegrade Cystourethrogram: A catheter is passed into the bladder through the urethra or directly from the abdomen. A dye is passed into the bladder and the catheter is taken out. As the person passes urine, dye comes out of the bladder. Multiple X-rays are taken to see the flow of dye through the urethra. In the area of stricture, narrowing in the passage of the dye is seen. This also helps to assess the location and the extent of the stricture.

Treatments for Urethral Stricture

The aim of treatment is to improve the urine flow and relieve symptoms. The type of treatment may depend on following factors:

  • Site of stricture in the urethra
  • Length of the stricture
  • Age and health of the affected person

Medications

Medications cannot treat an already formed stricture. However, antibiotics may be given to kill the microbes in case of a urinary infection.

Dilatation or Widening of the Stricture

Rods (also known as boogies) of increasing thickness are inserted in the urethra. This helps to stretch and dilate the narrowed part of urethra. The procedure may need to be repeated because stricture commonly recurs.  

Urethrotomy

A thin telescope is passed into the urethra to locate the site of narrowing. The part of the urethra that contains the stricture is cut using a small knife. This helps to widen the stricture. The procedure may need to be repeated because stricture commonly recurs.  

Permanent Urethral Stents

A thin tube with a camera at the tip is passed into the urethra. Through the camera, images inside the urethra can be seen on the screen. Through the tube a small and hard hollow tube, known as a stent, is passed into the urethra. The stent is made to fit in the narrowed part. A stent helps to keep the urethra open.

Surgery

Surgery may be needed if the above measures fail to relieve the symptoms. The aim of the surgery is to cure the stricture by removing the narrowed portion.

  • If the stricture is short, the narrowed portion is cut. The healthy portions of the urethra, before and after the stricture, are stitched together.
  • Grafting: If the stricture is longer, the narrowed portion is cut. But since a longer part of urethra is removed, it will not possible to join the before and after healthy parts of the urethra. The new part of the urethra is created by taking tissue from the other parts of the body, usually from inside the cheeks. This is known as grafting.

Side-effects and Complications

  • In people with Urethral Stricture, some urine remains inside the bladder while passing urine. This residual urine is more likely to become infected. So, the chances of infection of the bladder, prostate or the kidneys are higher in people who have Urethral Stricture. An infection causes high fever and pain in the abdomen. There may also be a burning sensation while passing urine.
  • Cancer may develop if there is Urethral Stricture for several years.  

  • Treatments used for Urethral Stricture may have following complications:

  • Urethral Stricture may recur after urethral dilation or urethrotomy. 

  • There may be excessive bleeding from the urethra after urethrotomy. 

  • Urethral stent may cause pain while sitting or during intercoure. 

  • During surgery for stricture, a part of the urethra may be removed. As a result, the length of penis achieved on erection may be reduced. The penis also bend, which is referred to as Chordee. However, grafting prevents these complications.

Self-care and Important Considerations

  • One may prevent Urethral Stricture by:
  • Practicing safe sex, using condoms. Avoiding sex with multiple partners or prostitutes.

  • Taking proper treatment for any infection of urethra. Proper treatment reduces chances of developing further urethral infections or problems.

  • Avoiding injuries to the lower abdomen region and the groin.  

  • People treated for sexually transmitted infection may get infected again if they have sexual contact with people who are infected with Chlamydia or Gonococcus. So, testing and treatment of sexually transmitted infection should be done in all the sexual partners. One should avoid sexual contact till the treatment is completed.

  • Various types of methods are available for treatment of Urethral Stricture. One should know about the benefits and complications of each mode of treatment before choosing one.

This article is developed by our team of Doctors/Experts. Last updated in 20th December,2010. Please see our Editorial board for details.
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