What is urethral stricture?

The urethra is the tube that urine flows out of from the bladder. In men, it passes through the prostate and the penis.  A urethral stricture is an abnormal narrowing of the urethra. Any section of the urethra may be affected and sometimes the whole urethra is affected. Urethral strictures are very rare in women.

The most common symptoms from urethral stricture include weak stream, dribbling, straining and incomplete emptying. Urethral strictures can also cause complications like urinary retention, urinary tract infection and epididymorchitis (infection of testicle).

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What causes urethral stricture?

Urethral stricture results from inflammation or injury to the urethra. This results in scarring and narrowing of the urethra. The most common injuries that can damage the urethra include medical instrumentation, radiation therapy, pelvic fracture and straddle injury. The most common infections that cause stricture are sexually transmitted infections such as gonorrhea and chlamydia.

How is urethral stricture treated?

An initial urethrotomy (cutting the stricture using a telescope) or a dilation (stretching with rods/balloon dilator) should be considered in all patients with a urethral stricture. This procedure may be done either under a local or a general anesthetic. The aim is to widen the stricture without causing additional scarring. The long term cure for dilation is less than 20%. Most strictures will gradually narrow again in a few months. Shorter strictures (<1cm) have a high chance of a cure with dilation/urethrotomy. Repeat dilation/urethrotomy is discouraged as it increases scarring and stricture length with each intervention.

A reconstructive procedure (urethroplasty) gives the best chance of cure from a urethral stricture. The type of surgery depends on the length and location of the stricture. In some, the area of scarring is removed and the remaining urethra is reconnected. In others, after the scar tissue is removed, a graft from inside the cheek (buccal mucosa) or a skin flap may be used to form a reconstructed urethra. Although these procedures are more invasive, they have a great cure rate (>80%) and studies have shown that the results are durable over many years.

The urologists at Medstar Georgetown University Hospital perform complex reconstructive surgeries for treatment of  urethral strictures.