Symptoms and causes

What is it?

A urethral stricture or urethra narrowing is a condition that typically occurs in men. There is a scar inside or around the urethra. The situation resembles a constriction in a garden hose: this constriction will slow down the jet power of the water. The same happens with a urethral stricture: the strength of the urine stream decreases or the stream becomes a spray rather than a normal straight stream. Sometimes, this is accompanied by pain when urinating or with blood in the urine.

The most frequent cause is an injury to the urethra: a fall on the rod of a bicycle, for example, can cause the formation of scar tissue; a difficult bladder catheter placement can also cause an internal injury that eventually turns into scar tissue; surgery throuth the urethra can also cause the formation of scar tissue over time. Occasionally a stricture can be caused by urinary infections. In many cases, no clear cause for the stricture can be identified.

Symptoms

In case of a severe stricture, there may be difficulties in emptying the bladder: after urinating, this leaves a residue of urine, which is predestined to cause repeated urinary inflammation.

In the case of a long-term stricture, the bladder may eventually lose muscular strength, resulting in even more residual urine.

With a very serious and long-term stricture, urinating itself can become completely impossible at some point: this is called urinary retention.

Diagnosis and treatment

Diagnosis

  • Uroflowmetry: This test measures the volume and the stream strength.
  • Urethrogram: An X-ray of the urethra is used to determine the severity, the length and the exact location of the urethra.
  • Urethroscopy: A fine camera is inserted through the penis to perform a visual inspection of the urethra and stricture.

Treatment

Different treatment options are available. The choice depends on the severity, length and exact location of the stricture, but also on the general condition of the patient, as well as his personal preference.

Dilatation

The urethra narrowing is 'stretched' by the urologist under local anaesthesia. Thicker and thicker dilators are inserted into the urethra. If the stricture returns quickly, the patient can be taught to insert a probe himself. Dilatation will often not cure the problem completely, but will (temporarily) improve the symptoms. Pain, bleeding and inflammation can occur after such dilatations.

Internal urethrotomy

Under general anaesthesia, a fine camera is inserted into the urethra. When the stricture becomes visible, it is incised with a minuscule knife or with a laser device. After this, a bladder catheter is placed to allow the internal wound to heal. After the procedure, bleeding, pain or inflammation may also occur. Unfortunately, even with this method of treatment, the risk of relapse is very high.

Urethraplasty

Urethraplasty is a surgical procedure performed by means of a skin incision to treat a urethra narrowing. There are different types of urethraplasties. The choice of type depends on the location and the length of the stricture. To treat a short stricture, it is often sufficient to excision the affected segment of urethra, after which the two ends are reconnected. If the stricture is too long for this approach, the removed piece of urethra can be repaired with tissue from elsewhere in the body. Different types of tissue can be used: typically skin or mouth mucosa. Such extensive urethroplasty are often complex operations, sometimes even two or three operations are necessary to fully repair the urethra. Usually, the patient will wake up from anaesthesia with a bladder catheter on site to allow the internal wound to heal. This approach also carries a risk of pain, bleeding and inflammation, not only in the urinary tract, but also at the level of the skin incision.

Latest publication date: 21/01/2021