Urethral Stricture

By Jill H. Osborne – Created April 22, 2015

I learned about urethral strictures when I was 12 years old. I had urinary frequency and urgency that, over time, made it difficult to sit through my classes and school and to sleep through the night. My urologist suspected that a narrowing of the urethra (urethral stricture) was making it difficult for me to empty my bladder and suggested weekly urethral dilations. I endured a more than 100 urethral dilations over several years before my symptoms thankfully improved.

While I realize that dilations were one of the most common treatments at that time, urologists in 2015 seek to understand the causes of strictures, particularly the growing role of the pelvic floor muscles and pelvic floor dysfunction in triggering urinary symptoms. I suspect that the reason I developed a stricture wasn’t due to infection or scar tissue but do to the early onset of pelvic floor dysfunction.

If you’ve been diagnosed with a urethral stricture, focus on the physical reality of having a narrow urethra. A medication will not make this go away. Rather, you’ll be working with your urologist to relax any tight pelvic floor muscles, open the stricture and/or reduce any scar tissue or blockage that may be present. The good news is that patients, like myself, respond well to treatment! Carry hope in your heart!

What are the causes of urethral stricture?

A urethral stricture can be the result of inflammation, infection (routine bladder or sexually transmitted disease) or injury. Direct physical accidents that damage or fracture the pelvis can result in urethra trauma and even separation. Similarly, straddle injuries (falling on the crotch area), prostate surgery, the removal of kidney stones, catheterization and cystoscopy can traumatize the urethra leading to stricture. The sexually transmitted disease chlamydia (formerly gonorrhea) is now the most common cause of inflammatory strictures.

What are these symptoms of urethral stricture?

Urethral stricture symptoms are similar to interstitial cystitis and overactive bladder with the patient experiencing increased urinary frequency and pain. However, a stricture will also reduce the flow of urine. Slow urine is a classic symptom as well as decreased urine output. With a urethral stricture, urine my sit for longer periods of time in the bladder thus increasing the risk of UTI. If long term and chronic, both infertility and kidney damage is possible.

frequent urination
painful urination
slow urine stream
decreased urine output
blood in the urine
urethral discharge
UTI
infertility
over the long term- kidney damage

Because men have much longer urethras than women, they are more susceptible to urethral stricture disease. It is considered rare in women. It is considered a medical emergency if urinary retention occurs and the patient is unable to urinate.

How is urethral stricture diagnosed?

Diagnosis is straightforward. Patients will have a physical examination, including a pelvic floor assessment to determine if pelvic floor muscles are contributing to the problem. A special procedure, a retrograde urethrogram, can help evaluate and locate the stricture to determine if surgical correction is necessary. This is an outpatient x-ray procedure. They insert a contrast dye into a urethra. It then allows the doctors to easily visualize the length of the urethra and where it is constricted. The ultrasound may also be performed over the area of the stricture to look at it more closely. Finally, the doctor may insert a small telescope into the urethra to look directly at the strictured area.

How can urethral stricture be prevented?

Urethral strictures are rarely the fault of the patient. Injury of the urethra and pelvic is a common cause. However, for patients who self-catheterize, care must be taken to practice sterile procedures and to use a lubricant jelly to ease the passage of the catheter through the urethra. Using a small catheter to avoid traumatizing the urethra is essential.

What are the treatments for urethral stricture?

Stricture cannot be treated with medicine. It requires some sort of physical manipulation to relieve the stricture.

Pelvic Floor Relaxation – If pelvic floor muscles are tight and constricted, physical therapy may be suggested and required.

Dilation – A urologist may perform a urethral dilation using progressively larger dilators to slowly stretch and relieve the stricture. Dilations may need to be repeated as necessary if the stricture recurs.

Urethrotomy – If the stricture involves scar tissue or a blockage of some type, a urologist may do a urethrotomy. A cystoscope with a special blade or laser at the end is inserted into the urethra and pushed to the stricture, which is then cut and/or reduced in size. The urologist may place a catheter to hold the urethra open while healing occurs.

Urethral Stent – A small metallic stent can be placed at the site of the stricture to prevent it from tightening and/or closing. Resembling a small chain link fence, the stent remains permanently at the site of the stricture. Unfortunately, it is very difficult to remove and can result in more serious scarring.

Surgical Methods – A variety of surgical methods (aka urethroplasty) can be utilized for more serious strictures, including: urethral reconstruction, removal of the stricture and substitution grafts to create a new urethra.

Additional Reading

Urethral Stricture Disease – Urology Care Foundation