Urethral stricture is an abnormal narrowing of the urethra, which may or may not impact the flow of urine from the bladder. Inflammation of the urethra can cause scarring, which then can lead to the development of a stricture or narrowing of the urethra. Potential causes include trauma, infection, tumors, surgeries, or prior instrumentation of the urethra. Urethral stricture is more common in males than females.
Symptoms of urethral stricture can include slow urine stream, dribbling of urine, split stream or spraying of urine, painful urination, hematuria (blood in urine), and discharge. Other patients may be free of symptoms.
Evaluation: To diagnose urethral stricture, the urologist must perform a cystoscopy or a retrograde urethrogram. Retrograde urethrogram is an x-ray of the urethra performed after injecting contrast into the urethra.
Treatment options: If symptoms are mild and the patient can empty his or her bladder well, observation is reasonable. In symptomatic patients, surgical intervention often is recommended and can include urethral dilation, direct vision internal urethrotomy, or urethral reconstruction.
Urethral dilation is a procedure wherein dilating tubes are passed through the urethra to open and dilate the scar.
Direct vision internal urethrotomy is performed by the urologist in the operating room. The urologist performs cystoscopy using a specially adapted cystoscope that is armed with a cutting instrument. The cutting instrument is used to incise the scar to reopen the narrow portion of the urethra. Urethral reconstruction is surgery performed by the urologist. An incision is made between the scrotum and the rectum, and the urethra is isolated. The scarred portion of the urethra is either excised or opened with the placement of a graft.