Conditions
URETHRAL STRICTURE DISEASE
Urine passes from the bladder through a thin tube out the body known as the urethra. In men, the urethra also carries semen, playing an important role in ejaculation. When the urethra becomes constricted or blocked due to an infection, swelling, injury, it is known as a urethral stricture. This stricture can occur at any part of the urethra, and this narrowing restricts or slows the flow of urine.
Men are more likely to have a urethral stricture disease or injury because they have a longer urethra than women. In most cases, this constriction of the urethra is caused by injury to the scrotum or perineum, damage from surgical tools such as a urinary catheter or kidney stone removal that cause inflammation or scar tissue.
A urethral stricture is commonly categorised by symptoms of:
- Weak flow of urine
- Urine flow that stops and starts
- Feeling like the bladder isn't completely empty after urination
- Sudden urge to urinate
- Pain in the lower abdomen or pelvic area
- Pain when urinating
- Blood in the urine or semen
- Inability to urinate (this require emergency medical attention)
- What are the treatments for urethral strictures?
Treatment of a urethral stricture will depend on the size of the blockage, the area in which the blockage has occurred, and how much scar tissue is involved. Your urologist will be able to determine the most suitable treatment option for your specific case using diagnostic urine and blood tests for an accurate diagnosis. Dr Ridgard may also suggest a urethroscopy, retrograde urethrogram and an x-ray or ultrasound of the urethra to see exactly where the stricture is.
Treatment of stricture can only be done with a surgical approach. There are three approaches to the treatment of this condition:
Urethral dilatation
Urethral dilation involves enlarging the stricture with gradual stretching using a dilator. A special balloon is attached to the catheter, which, once inserted into the urethra, is blown up to dilate the narrowed area.
Internal urethrotomy
Using a specialised scope, the stricture in the urethra is located. Once found, a laser or blade is used to cut the stricture and create a gap. Thereafter a catheter may be placed to allow the gap to heal properly.
Urethroplasty
Urethroplasty involves the surgical reconstruction or replacement of the urethra. This method usually provides the best results long-term. As a urologist experienced in these surgeries, Dr Ridgard will make an incision between the scrotum and rectum to gain access to the stricture. Depending on the length of the stricture, it is then removed, and the urethra is reconnected or reconstructed. In some cases where the stricture is fairly long, the section of the urethra may need to be replaced. The three kinds of substitution procedures are:
- Free graft
- Skin flap
- Staged
After either of these surgeries, you will need to stay in the hospital for observation. A catheter is placed and will remain in place for several days to allow healing. An X-ray is taken to make sure the repair has healed. Because urethral strictures can reoccur, your urologist will want to see you again for check-ups and monitor the repair's success.
FAQ
Bleeding from the urethra indicates that the scar was ruptured, and the stricture will soon recur, worsening the length and density of the stricture. Long-term success is weak, with significant recurrence rates. The stricture will return if interval dilatation is stopped.
A urethral stricture, if left untreated, can lead to significant complications such as bladder and kidney damage, infections caused by the restriction of urine flow, and inadequate ejaculation and infertility in men. Strictures, fortunately, can be successfully treated.
The most usual time for urethral strictures to develop is one to three years after radiation therapy. However, because the development of urinary symptoms is a gradual and progressive process, many patients do not receive a diagnosis for several years.
