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Dealing with Urethral Stricture: Diagnosis and Management

What is the urethral stricture?

The urethra is a tube that transports pee from the bladder to the outside. The urethra is usually wide enough to allow urine to flow freely. Narrowing of the urethra can restrict urinary flow. We know it as a urethral stricture. Medical ailment urethral stricture primarily works in men. Many men with strictures will experience increased urination discomfort and a slowdown in the urine stream. 

A Happy Male After Urethral Stricture Procedure

This process can happen over time, resulting in pushing or straining to get urine out. In others, the condition will appear suddenly and without warning, causing immediate attention. Through the urethra, the bladder empties and exits the body (called voiding). Urine from the bladder must travel a longer distance through the penis in males. We define the posterior urethra through which urine travels in males.

What are the causes of urethral stricture? 

Urethral stricture involves the constriction of the urethra. A urethral stricture occurs due to tissue inflammation or scar tissue. Scar tissue can result from many factors. Men with penile implants have a higher chance of developing urethral stricture. A typical type of trauma that can cause urethral stricture is a straddled injury. Falling on a bicycle bar or being injured in the area near the scrotum are examples of straddled injuries. Other causes of urethral stricture include pelvic fractures,

• Catheter insertion and prostate radiation treatment.
• Benign prostatic hyperplasia (BPH) causes the prostate gland to grow.
• Untreated or recurrent urinary tract infections, sexually transmitted infections (STIs), 
• Gonorrhoea and chlamydia are all rare causes.

What are the risk factors for urethral stricture?

Some male patients have an elevated risk of developing urethral stricture, especially those who have:

• Experienced one or more STIs (sexually transmitted infections).
• Recently underwent catheter placement (inserted a small, flexible tube into the body to drain urine from the bladder).
• Experienced urethritis (swelling and irritation in the urethra), possibly due to an infection.
• Some male patients have an enlarged prostate.

What are the symptoms of urethral stricture?

Urethral strictures can cause many symptoms, ranging from mild to severe. Some signs of urethral stricture include:

• a decrease in urine volume or weak urine flow
• Urge to urinate frequently, 
• Sense of incomplete bladder emptying after urination, 
• While urinating, experience pain or a burning sensation.
• Inability to keep urinating under control (incontinence)
• pelvic or lower abdominal discomfort
• penile swelling, 
• Penile swelling and pain 
• discharge of blood or sperm from urine
• Darkening of urine 
• inability to urinate (this is a life-threatening condition that requires emergency medical intervention)

How do urologists diagnose urethral strictures?

Surgeons may use several approaches to diagnose urethral stricture. Doctors can review your symptoms and medical history. You can report the symptoms mentioned above. Your doctor may inquire about past illnesses and medical procedures to determine whether one or more risk factors are present.

How do urologists can perform a physical examination?

A simple physical examination of the penis area can help identify a urinary stricture. For instance, the doctor observes redness (or urethral discharge) and finds out if one or more regions are solid or swollen.

How do urologists conduct the tests?

They may analyze the physical and chemical properties of urine. They may decide if bacteria (or blood) are present. To ensure a definite diagnosis of urethral stricture, urologists may need to perform one or more of the following tests:

1. Urologists may measure the rate of flow during urination.
2. Urologists may insert a small tube to view the inside of the bladder and urethra (the most direct way to check for stricture. The name of the test is Cytoscopy. 
3. Urologists may measure the size of the urethral opening.
4. They may test for chlamydia and gonorrhoea.

How is urethral stricture treated?

Many options depend on the blockage size and the scar tissue intensity. 

Surgical treatments include:

1. Dilation—enlarging the stricture with slow stretching
2. Urethrotomy—cutting the urethral stricture with a laser or knife through a scope
3. Open surgery- Surgically remove urethral stricture, reconnect, and reconstruct, potentially using grafts (urethroplasty).

There is no available medicine to avail treatment strictures. Without treatment, problems with voiding will persist. Urinary and testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can't pass urine), which leads to enlarged bladder and kidney problems.

What is the dilation technique in urethral stricture treatment?

The urologist typically performs this procedure in their clinic under local anaesthesia. Dilation, an outpatient procedure, involves passing a wire across the stricture and progressively stretching the opening with larger dilators. Specifically, Urologists place a catheter for a few days after this procedure. Dilation is a temporary management strategy and not curative.

What is Urethrotomy?

Surgeons achieve a direct vision of the stricture. To avail of this facility, doctors use a cystoscope (fiberoptic camera) up to the stricture point. It passes through a blade to cut the scar tissue open to re-create a wide opening in the urethra. Surgeons have to place a catheter for one week. The patient will get cuts or stitches in the skin. Urethrotomy is most effective for very short strictures less than one centimetre long. Potential side effects include bleeding, infection, stricture recurrence, urine leakage, and erectile problems.

What is urethroplasty in urethral stricture treatment?

Several reconstructive options are available to remove the stricture and recreate the urinary tube. Surgeons consider this open surgical procedure the gold standard for stricture correction. With long-term success rates from 80 to 95 per cent depending on location, length, and concurrent conditions, urethroplasty provides the most durable results for urethra reconstruction. Urologists perform such procedures in two to three hours for an outpatient procedure. They require a urethral catheter for four weeks. In other surgical procedures, they employ anastomotic urethroplasty for short strictures of the bulbar urethra. Urologists removed a section of the scarred urethra, and after that, they sewed the two ends back together. The success rate of anastomotic urethroplasty is 90-95 per cent. 

Happy patient After Urethral stricture treatment

What is substitution graft urethroplasty?

We use substitution graft urethroplasty for longer strictures greater than two centimetres and penile urethra scar tissue. An oral surgeon harvests a piece of tissue from the mouth (buccal mucosa). Urologists use mouth grafts to reconstruct the urethra by patching the damaged area and increasing the tube size. Long-term success is approximately 80-85 per cent.

What has staged urethroplasty?

Staged urethroplasty is a recherche technique used for the worst strictures. We employ it for urethras that get damaged for virtually the entire length. This option involves multiple staged surgeries before the urethra for total repair.

What is the perspective of urethral stricture?

Urethral stricture has a positive outcome. It is a treatable condition. However, this condition can transpire again, requiring multiple procedures.