Due to advances in diagnostic technology, the extent of strictures in the urethra can often be determined with better accuracy.
If the tube that carries urine out of the body from the bladder (the urethra) becomes blocked or constricted in some way, the result is often difficulty urinating. One possible reason for this is scarring in the urethra, referred to as urethral strictures.
Occurring more frequently in men, urethral strictures may develop for several reasons, including an injury, infection, or inflammation.
The exact causes of urethral strictures isn’t known, although there are certain risk factors and circumstances that can increase the risk of developing scar tissue. Some people develop scarring after having an endoscopic procedure done with a scope that’s inserted into the urethra, while others may develop strictures because of prolonged use of a catheter. Risk factors also include:
Urethra or pelvis trauma
Prostate engagement or previous prostate surgery
Urethral or prostate cancer
Having had radiation therapy
STDs or infections
Signs and Symptoms
In men, scarring can occur anywhere from the bladder to the tip of the penis. Disruption of urine flow is the most common symptom associated with urethral strictures. Some patients also develop related urinary tract infections or conditions such as prostatitis and kidney damage due to urine retention. Symptoms may also include frequent urination, “sprays" during urination, incomplete bladder emptying (voiding), and blood in urine.
Diagnosing Urethral Strictures
Following an initial examination by a urologist, making a positive diagnosis of urethral strictures usually involves a full bladder dysfunction workup. This includes a urinalysis, a urine study to measure flow, urine cultures to rule out infections, and post-void evaluations to determine how much urine is left in the bladder after urinating. Image tests are sometimes done if related problems with the urinary system are suspected. A retrograde urethrogram (RUG) may be performed to determine the severity of the stricture.
Possible Treatment Options
Treatment will depend on the extent of the strictures and how much disruption they are causing with urine flow. In some situations, the scar tissue is progressively stretched with a technique called dilation. Some patients benefit from a urethrotomy, a procedure performed with a special type of cystoscope to cut away the scar tissue. A catheter is sometimes temporarily used to hold the urethra open to allow tissues to heal post-surgery. With a urethrotomy, reconstructive surgery is usually necessary to restore the function of the urethra to restore normal urine flow. In some cases, the only treatment recommended may be periodic examinations, especially if symptoms are mild and there are no other issues with the bladder, kidneys, and other structures.
Symptoms associated with urethral strictures are similar to what may be experienced with other urinary system conditions. Therefore, it’s important to be proactive and let your doctor know if you are noticing changes in your urination patterns. If a problem with your urinary system is suspected, you’ll likely be referred to a urologist for further evaluation.