Treatment of Urethral Stricture

About the disease

Urethral stricture is the narrowing of the urethra, usually due to scar tissue or inflammation from an infection. The urethra is the tube that transports urine from the bladder to the urethral orifice, so if it becomes narrowed it can cause difficulty and pain when urinating. In severe cases, it can cause urinary retention (inability to urinate).

Common causes of urethral stricture include injury to the groin and thighs area (straddle injury) and penile fracture. Both can cause scarring, especially if medical treatment was not sought at the time. Medical conditions, such as problems with the kidneys or bladder, often mean that patients are required to wear a catheter to assist urination. Although this is a very useful device (and sometimes absolutely necessary), it can lead to scarring in the urethra, especially if it has not been fitted well.

In rare cases, urethral stricture can develop as a result of a congenital condition that affects males, known as hypospadias. This is a condition whereby the urethra does not descend to the normal position of the tip of the penis. Rather, the opening through which urine is passed (the urethral meatus) appears somewhere along the underside of the penis shaft or even in the scrotal area. Usually, boys born with this condition have reconstructive surgery early in life, so that they do not have any problems with urination later in life. Nonetheless, this kind of surgery can lead to scarring, which is why regular check-ups are necessary to avoid complications.

Symptoms

• Pain when urinating
• Difficulty urinating
• Swollen penis
• Dark urine
• Blood in the urine, in some cases
• Discharges from the penis
• Blood in the sperm, in some cases

Diagnosis

• During a general examination, the doctor will examine the patient’s genitals, to check for swelling or lumps, which can indicate problems with the urethra.
• The doctor will ask the patient if they have ever had any traumas or injuries in this area.
• The doctor may suggest that the patient undergoes STD tests, to find out if an infection could be causing urination problems.
• A cystoscopy is a local imaging test that enables the doctor to examine the urethra by inserting a thin lighted tube into it.
• An X-ray with contrast dye creates a clear picture of the urethra, which can help to determine whether there is any scarring or narrowing.

Treatment

• An endoscopic urethrotomy is a minimally invasive procedure, whereby a small incision is made in the urethra, to provide relief from the stricture.
• Resection with reconstruction is a surgical procedure which resects and then reconstructs the urethra, so that urination is painless and flows normally again.
• The implantation of a transurethral splint (a special supporting device) inside the urethra can improve the patient’s ability to urinate normally.
• Bougienage is a special procedure, whereby the urethra is widened so that urine can flow out unhindered from the bladder to the urethral meatus.
• Urethra plastic isa surgery reconstructs the urethra and normalizes its function. 

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko