Urethral stricture

• What is Urethral Stricture
• Statistics on Urethral Stricture
• Risk Factors for Urethral Stricture
• Progression of Urethral Stricture
• Symptoms of Urethral Stricture
• Clinical Examination of Urethral Stricture
• How is Urethral Stricture Diagnosed?
• Prognosis of Urethral Stricture
• How is Urethral Stricture Treated?
• Urethral Stricture References

What is Urethral Stricture

Urethral Stricture is a disorder of the urethra – The conduit connecting the bladder to the external environment. Urethral stricture is an abnormal narrowing of the urethra (the tube that releases urine from the body).

Statistics on Urethral Stricture

No formal studies of disease incidence have been published. This condition occur predominantly in males for the male urethra is 6-7 times longer than the female urethra, allowing both infection and surgical damage to occur more frequently.

Risk Factors for Urethral Stricture

There are a number of factors that predispose the development of this condition. The condition may occur due to infection or trauma of the urethral part of the urinary tract.

Trauma factors:

1. Previous surgery upon the urinary tract.
2. Presence of cancer in adjacent structures such as the prostate.
3. Presence of a long-term urinary catheter.

Infection prediposing factors include:

1. Other urinary tract abnormalities.
2. Frequent participation is unprotected sexual intercourse.
3. Poor functioning immune system.

Progression of Urethral Stricture

As mentioned in microscopic features, current opinion holds that urethral stricture does not occur over the short term, but is a progressive condition caused by urine leaking into tissues around the urethra. The initial damage is done through trauma and/or infection, which leads to permanent changes of the urethral lining, and long-term leakage of urine into the tissues around the urethra. The urethral stricture will progressively become more severe, and partially or somtimes totally obstruct the passage of urine to the external environment. These changes may lead to complications of urinary incontinence and kidney probelsm if left untreated.

How is Urethral Stricture Diagnosed?

As urethral strictures may be caused by sexually transmitted infections, the patient may be tested for a number of STI’s that relate to the urethral stricture itself, and others which may occur in association with sexually transmitted infection. This will require blood samples to be taken from the patient. A urinary sample will also be required to test for the presence of the urinary tract infection.

Prognosis of Urethral Stricture

With surgical repair, the prognosis of this condition is good. The most commonly performed procedure is called an “anastamotic repair of the urethra.” Essentially the narrowed segment of the urethra is removed and the remaining ends attached together. The success rate for this procedure is greater than 90%. The recurrence rate following anastomotic repair is very low.

How is Urethral Stricture Treated?

The most common treatment for this condition is the use of dilators, to expand the narrowed segment of urethra. Dilating rods are passed into the urethra to expand the narrow segment of urethra. This form of therapy provides good relief from symptoms in the short term, but the procedure will often need repeating as the stricture will commonly recur after this procedure. This condition may also be corrected with surgery. The successful surgical procedure performed is the anastomotic repair of the urethra. The narrowed segment is surgically removed and the ends are connected surgically. This procedure will require admission to a hospital and the insertion of a catheter following the procedure to allow the urethra to heal and allow urine to pass easily, throughout the post-operative period.

Urethral Stricture References

1. Andrich DE, Mundy AR. Urethral strictures and their surgical treatment. BJU International 86:571-580.
2. Tjandra JJ, Clunie GJ, Thomas RJ. Textbook of Surgery 2nd Edition. Blackwell Publishing, UK 2001.
3. Way LW. Surgical Diagnosis and Treatment 10th Edition. Appleton and Lange, USA 1994.