Urethral stricture is an abnormal narrowing of the urethra. Urethra is the tube that carries urine out of the body from the bladder.
Urethral stricture may be caused by swelling or scar tissue from surgery. It can also occur after a disease or injury. Rarely, it may be caused by pressure from a growing tumor near the urethra.
Other factors that increase the risk for this condition include:
- Sexually transmitted infection (STI)
- Procedures that place a tube into the urethra (such as a catheter or cystoscope)
- Benign prostatic hyperplasia (BPH)
- Injury to the pelvic area
- Repeated urethritis
Strictures that are present at birth (congenital) are rare. The condition is also rare in women.
- Blood in the semen
- Discharge from the urethra
- Bloody or dark urine
- Strong urge to urinate and frequent urination
- Inability to empty bladder (urinary retention)
- Painful urination or difficulty urinating
- Loss of bladder control
- Increased frequency or urgency to urinate
- Pain in the lower abdomen and pelvic area
- Slow urine stream (may develop suddenly or gradually) or spraying of urine
- Swelling of the penis
Exams and Tests
A physical exam may show the following:
- Decreased urinary stream
- Discharge from the urethra
- Enlarged bladder
- Enlarged or tender lymph nodes in the groin
- Enlarged or tender prostate
- Hardness on the under surface of the penis
- Redness or swelling of the penis
Sometimes, the exam reveals no abnormalities.
Tests include the following:
- Postvoid residual (PVR) volume
- Retrograde urethrogram
- Tests for chlamydia and gonorrhea
- Urinary flow rate
- Urine culture
The urethra may be widened (dilated) during cystoscopy. Topical numbing medicine will be applied to the area before the procedure. A thin instrument is inserted into the urethra to stretch it. You may be able to treat your stricture by learning to dilate the urethra at home.
If urethral dilation cannot correct the condition, you may need surgery. The type of surgery will depend on the location and length of the stricture. If the narrowed area is short and not near the muscles that control the exit from the bladder, the stricture may be cut or dilated.
An open urethroplasty may be done for longer strictures. This surgery involves removing the diseased area. The urethra is then rebuilt. The results vary, depending on the size and location of the stricture, the number of treatments you have had, and the surgeon's experience.
In acute cases when you cannot pass urine, a suprapubic catheter may be placed. This is an emergency treatment. This allows the bladder to drain through the abdomen.
There are currently no drug treatments for this disease. If no other treatments work, a urinary diversion called an appendicovesicostomy (Mitrofanoff procedure) may be done. This lets you drain your bladder through the wall of the abdomen using a catheter.
The outcome is often excellent with treatment. Sometimes, treatment needs to be repeated to remove scar tissue.
Urethral stricture may totally block urine flow. This can cause sudden urinary retention. This condition must be treated quickly. Long-term blockage can lead to permanent bladder or kidney damage.
When to Contact a Medical Professional
Call your health care provider if you have symptoms of urethral stricture.
Practicing safer sex may decrease the risk of getting STIs and urethral stricture.
Treating urethral stricture quickly may prevent kidney or bladder complications.
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Bellinger MF. Urologic disorders. In: Zitelli, BJ, McIntire SC, Norwalk AJ, eds. Atlas of Pediatric Diagnosis. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 14.
McCammon KA, Zuckerman JM, Jordan GH. Surgery of the penis and urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 40.