Overview
Urehtral strictures are where the lining of the urethra has experienced scarring, which causes a narrowing. Strictures can be small, less than 1cm, or they can extend along the entire length of the urethra.
Causes
Strictures can have a number of causes:
- Sexually transmitted infections
- Injuries to the urethra
- Medical treatments such as urological procedures
Symptoms
If a person has a minor stricture, they may not notice any symptoms, but if it more severe then the following may be experienced:
- Difficulty passing urine
- Spraying or splitting of the urinary stream
- More frequent need to pass urine
- Urinary tract infections
- Pain in passing urine
- Reduced force of ejaculation
Diagnosis
If a person has reported any of the symptoms above, then an examination may be carried out, as well as additional tests if needed:
- An ultrasound may show that the bladder is not completely empty after passing urine
- An examination may be able to identify a visible narrowing at the tip of the penis
- If a telescope or catheter cannot be passed
- A urethrogram will use contrast dye to reveal the anatomy and measure any narrowing
- MRI
Treatment
As with most conditions, the treatment will depend on each individual case, taking into account factors such as the site and length of the stricture and its cause.
A patient may only require monitoring if the symptoms are not causing problems or if the risks outweigh any intervention. However, there are other treatments that may be required.
Urethral or Meatal Filatation
The urethra or urethral opening is stretched, using metal or plastic dilators. Gradually the size increases to improve the stretching. A telescopic inspection may be carried out, in order to fully assess the condition of the urethra. After this, a small internal cut will be made, and there is no need for any external stitches.
The procedure will be carried out under a general anaesthetic, but in some patients, they may have an epidural anaesthetic.
Internal urethrotomy
A telescope is passed through the urethra in order to cut the stricture. This opens up the scar tissue that caused the stricture. There is a chance that another stricture may develop in the future.
Urethroplasty
The diseased or scarred section of the urethra is repaired during an operation, to prevent the recurrence of the stricture. This has a higher success rate in curing symptoms and preventing future strictures compared to other treatments
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