Urethral stricture refers to a contraction of the urethral space resulting from poor catheter manipulation, friction, infection or other unexplained causes. The magnitude of the strictures (narrowing) varies from less than 10 mm to the full length of the urethra. There are two types of strictures:
Posterior Urethral Stricture
Originates at the base of the urethra, right after the urethral sphincter, and normally extends for up to 2”. Posterior Urethral Strictures can involve fissures or other acute urinary obstruction requiring emergency insertion of a suprapubic catheter (until surgical repair is performed). Less severe strictures where urethral continuity is not disrupted can be approached with catheters inserted through the urethra.
Anterior Urethral Stricture
Occurs in the outermost part of the urethra (close to the Labia Majora in women and to the Glans Penis in men) and can extend posteriorly for up to about 10″.
Both strictures are more prevalent in men since the male urethra is proportionally much longer and therefore more prone to issues than that of women and children.
- Complications voiding urine.
- Frequent episodes of Urinary Tract Infection (UTI).
- Acute urinary retention.
- Weak urine stream.
- Incomplete bladder emptying.
- Spraying of urine.
- Pain when urinating (Dysuria).
- Semen with blood traces.
- Abdominal soreness.
- Urine leaks.
Other rare symptoms include urethral fistula, Periurethral abscesses, and hydronephrosis.
Treatment depends on various factors including cause, location, and length of the stricture. Options include surgical reconstruction (using flaps), urinary diversion procedures (perineal urethrostomy and suprapubic catheter), and some minimally-invasive therapies such as urinary dilation and endoscopic urethrostomy. There is no single technique. There may be multiple treatments used on the same patient.
- Urinary dilation: The dilation is performed using filiforms and followers under endoscopic control. This is an initial treatment method used for strictures of less than 20 mm with no associated spongiofibrosis. The procedure can also be taught to patients so that they can perform it themselves.
- Endoscopic urethrostomy: DVIU (Direct vision internal urethrostomy) is mostly performed after axial urinary dilation. It involves making an urethrostomy incision with a Holmium laser (it can also be done with a cold-knife urethrotome). This technique is highly successful for short and tight strictures, but for longer and complex ones it has a higher failure rate.
During the treatment for a urethral stricture, a complete general anesthetic is used. The patient is given prophylactic antibiotics before the treatment starts. The surgeon inserts a telescope through the urethra. Using plastic dilators, the opening is stretched and anesthetic jelly is used to numb and lubricate the passage. Dissecting is performed internally in the urethra so there is no need for stitches or incisions. The average hospital stay after the surgery is one night. A urinary catheter must be used for at least 24 hours after that.
- Moderate burning sensation or bleeding after passing urine.
- Recurrence of narrowing requiring further treatment.
- Collection of bladder stones or abnormalities in bladder.
- Bladder Infection.
Rare side effects include:
- Urine leakage.
Decrease in occurrences and duration of erections.