The urethra is the tube that carries the urine from the bladder to the tip of the penis. Any narrowing or scarring in this tube can result in difficult urination and this narrowing is what the experts like urologist in Karachi call urethral stricture. Read on to know more about urethral stricture, its causes, diagnosis and treatment options:
What is urethral stricture?
Narrowing of the urethra—the tube that carries urine out of the bladder—is called urethral stricture. In normal un-diseased state, the urethra is wide enough for the urine to flow freely. However, when there is narrowing due to any cause, it impedes the flow of urine and this is known as urethral stricture.
Urethral strictures are more common in men. In some, the symptoms appear gradually, with slowing of the urinary stream, followed by straining while urination. In others, urethral stricture can appear acutely, needing immediate medical care.
Urethral strictures are less common in women, and the causes and treatment options are different from men. The scar tissue in female urethra can also cause bothersome symptoms and need management with dilation or cutting of the stricture.
What are the symptoms of urethral stricture?
In men with urethral stricture, the following symptoms may be seen:
- Feeling of incomplete voiding
- Weak urinary stream
- Straining while urinating
- Frequent urges to urinate
- Pain during urination
- Urethral discharge
- Swelling of the penis
- Dark urine
- Inability to control the urine stream
- Difficulty in starting and stopping the urinary stream
- Complete inability to urinate is a serious symptom needing immediate management
What are the causes of urethral stricture?
Commonly, urethral strictures appear after injury or medical conditions with chronic inflammation. In both cases, the consequence is scar tissue formation, which causes narrowing. Other causes include:
- Trauma to the perineum such as saddle injury, or trauma to the scrotum or penis, such as during road traffic accidents.
- Scarring can also occur following difficult or forceful catheterization or instrumentation into the urethra in surgical procedures.
- Sexually transmitted infections like chlamydia can result in constant inflammation and scarring.
- Men with penile implants are at higher risk of urethral strictures
- Corrected hypospadias in young age can also predispose to urethral strictures
- Radiation to the perineum can also result in stricture formation
- Benign prostatic hyperplasia is another cause of urethral stricture
- Rarely, a tumor can be located in close proximity to the urethra that can cause it to become narrow
- Untreated infections of the urinary tract can also cause stricture formation.
How is urethral stricture diagnosed?
The diagnosis of urethral stricture is made through the following investigations:
- Imaging tests called retrograde urethrogram in which dye is injected into the urethra and x-ray is taken thereafter, to assess the length and density of the stricture.
- Urine flow tests
- Cystoscopy—in which a fiberoptic scope is inserted into the urethra under local anesthesia to assess the stricture
What are the treatment options?
The treatment options are based on the severity of the condition, the size of the stricture and the causative factor. The non-surgical treatment options include:
Dilation of the urethra
Urethra is dilated through a dilator in an outpatient procedure. A small wire is first passed through the urethra and gradually this is dilated to break the stricture. The common issue with this treatment is the return of the stricture.
Permanent catheter placement
This nonsurgical option includes placing a permanent urinary catheter in the bladder. This option is reserved for very severe cases and involves risks like bladder irritation and persistent urinary tract infections.
The surgical treatment options include:
Urethroplasty and urethral reconstruction
This is done by removing the scar tissue and suturing the urethra back. Skin flaps are often used in this reconstruction. When done right, this procedure offers better prognosis.
In the long run, most treatment options for urethral stricture offer good outcome, particularly when performed by experts like urologist in Lahore.