Urethral stricture: What are the causes?
The cause of a urethral stricture is usually due to tissue inflammation or the presence of scar tissue. Various factors can cause this:
- A crush injury is a common type of trauma. Examples of such injuries are a fall onto a bicycle pole or a blow near the scrotum.
- An infection, usually with sexually transmitted pathogens such as chlamydia.
- The insertion of catheters or other surgical instruments into the urethra as part of an operation.
Risk factors
Some men have an increased risk of developing a urethral stricture. The risk factors include:
- Recurrent urethritis
- Operations through the urethra
Urethral stricture: symptoms
Symptoms that indicate a urethral stricture could be:
- Pushing when urinating
- Feeling of incomplete bladder emptying
- Constantly weakened urine stream
- Long time to empty the bladder
- Pain during urination
- Urge to urinate
Some patients with severe urethral strictures are no longer able to empty their bladder. This is known as urinary retention and is a medical emergency. As a result, the heavily filled bladder can cause urine to back up into the kidneys. Urinary retention lasting for weeks can lead to a deterioration in kidney function.
Urethral stricture: diagnosis and tests
There are various tests that the doctor can use to determine whether the patient is suffering from a urethral stricture:
- Imaging procedures (retrograde urethrography)
- Urethroscopy (urethroscopy)
Non-invasive tests can reveal problems with emptying the bladder, but cannot reliably diagnose a stricture.
Urethroscopy
During urethroscopy, a flexible camera is inserted into the urethra up to the constriction. This allows the constricted area to be viewed.
Retrograde urethrography
This examination can be used to determine the number of strictures as well as their position and length. Retrograde urethrography is an outpatient X-ray examination. Contrast medium (liquid that is visible on an X-ray image) is injected via the entrance to the urethra. This shows the entire urethra and the urethral stricture on the X-ray image.
Urethral stricture: prevention
There is no sensible prevention. It is important to consult a doctor immediately if signs of urethral stricture occur.
Urethral stricture: treatment
The exact treatment for urethral stricture depends primarily on the extent of the narrowing and scarring.
The treatment options include:
- Dilatation: widening of the constriction
- Urethrotomy: cutting through the constriction with a laser or scalpel from the inside
- Open surgery: surgical removal of the stenosis with reconstruction.
One possible treatment method is to dilate the urethra using a dilator. The dilators are inserted into the urethra according to size, thus widening the constriction. During urethrotomy, a blade or laser is inserted into the urethra through the endoscope under visualization and the stricture is cut. During urethroplasty, the scar tissue is removed and the ends of the urethra are then stitched back together. Depending on the length of the constriction, a replacement tissue in the sense of the oral mucosa must be used to cover it.
