Urethral Stricture

What is a urethral stricture? 

A urethral stricture is a narrowing of the urethra which can be cause by injury, instrumentation, infection and particular non-infectious urethritis. 

Symptoms

  • Splaying urinary stream
  • Urinary frequency
  • Urinary urgency 
  • Difficulty urinating (e.g. straining)
  • Pain during urination
  • Urinary tract infection 
  • Prostatitis 
  • Inability to completely empty the bladder
  • Severe strictures can cause a complete inability to urinate. This is referred to as acute urinary retention, and is a medical emergency. 

Causes

Urethral strictures most commonly result from injury, instrumentation, infection, non-infectious inflammatory conditions of the urethra, and post prior hypospadias surgery. Less common causes may include congenital urethral strictures and those resulting from malignancy. 

Treatment

  • Dilation - a procedure in which the urethral diameter is expanded by passage of sequentially larger sounds or dilators.
  • Urethroplasty - open reconstruction of the urethra.
  • Urethral Stent

Where there is acute urinary retention, treatment of the urethral stricture or diversion is an emergency. Treatment options include: 

  • Urethral dilatation and catheter placement. This can be performed in the Emergency Department, a practitioner's office, or an operating room. The advantage of this approach is that the urethra may remain patent for a period of time after dilation, however long-term success rates are low. 
  • Insertion of a suprapubic catheter with catheter drainage system. This is performed in an operating room under general anaesthetic. The benefit of this approach is that it does not disrupt the scar and interfere with future definitive surgery. 

Ongoing Care

After a urethroplasty, individuals should be monitored for a minimum of one year, as most recurrences occur with a year.