Urethral stricture refers to a narrowing of the urethra, the tube that carries urine from the bladder to the outside of the body. This narrowing restricts the flow of urine, leading to various uncomfortable and potentially serious symptoms. This article provides an overview of the causes, symptoms, diagnosis, and treatment options for urethral stricture.
Causes of Urethral Stricture
Urethral strictures typically result from scar tissue formation within the urethra. Common causes include:
- Injury: Trauma to the urethra, such as from a pelvic fracture or straddle injury.
- Infection: Sexually transmitted infections (STIs) like gonorrhea or chlamydia can cause inflammation and subsequent scarring.
- Medical Procedures: Catheterization or endoscopic procedures can sometimes injure the urethra, leading to stricture formation.
- Inflammation: Chronic inflammation of the urethra, such as from lichen sclerosus.
- Unknown Causes: In some cases, the cause of urethral stricture remains unknown (idiopathic).
Symptoms of Urethral Stricture
The symptoms of urethral stricture vary depending on the severity and location of the narrowing. Common symptoms include:
- Weak Urine Stream: Reduced force and flow of urine.
- Straining to Urinate: Difficulty initiating urination or needing to strain to empty the bladder.
- Slow Urination: Prolonged time to complete urination.
- Painful Urination: Discomfort or pain during urination (dysuria).
- Frequent Urination: Increased urge to urinate, often with small amounts of urine.
- Urinary Retention: Inability to completely empty the bladder.
- Urinary Tract Infections (UTIs): Increased susceptibility to UTIs due to incomplete bladder emptying.
- Blood in Urine: Hematuria may occur in some cases.
Diagnosis of Urethral Stricture
Diagnosing urethral stricture involves a thorough medical history, physical examination, and various diagnostic tests, including:
- Uroflowmetry: Measures the rate and volume of urine flow to assess the degree of obstruction.
- Post-Void Residual (PVR) Measurement: Determines the amount of urine remaining in the bladder after urination.
- Urethroscopy: A thin, flexible scope is inserted into the urethra to visualize the narrowing and assess its location and severity.
- Retrograde Urethrogram (RUG): X-ray imaging of the urethra after injecting contrast dye to identify strictures.
- Voiding Cystourethrogram (VCUG): X-ray imaging during urination to evaluate the urethra and bladder function.
Treatment Options for Urethral Stricture
Treatment for urethral stricture aims to relieve obstruction and restore normal urinary flow. Options include:
- Urethral Dilation: A minimally invasive procedure where the urethra is gradually widened using dilators of increasing size. This can be performed in an outpatient setting with local anesthesia.
- Self-Catheterization: Some individuals may be taught to periodically insert a catheter into the urethra to keep it open.
- Urethrotomy: A small incision is made to cut the stricture, often using a laser or knife inserted through a scope.
- Urethroplasty: Surgical reconstruction of the urethra, involving removal of the stricture and either direct re-connection of the urethra or grafting tissue from another part of the body (e.g., mouth lining) to enlarge the urethra.
- Urethral Stent: Placement of a mesh tube to keep the urethra open.
The choice of treatment depends on the length, location, and severity of the stricture, as well as the individual’s overall health and preferences.
Takeaway
Urethral stricture can significantly impact quality of life, but effective treatments are available to restore normal urinary function. Early diagnosis and appropriate management are essential to prevent complications such as urinary retention, UTIs, and kidney damage. Individuals experiencing symptoms of urethral stricture should seek prompt medical evaluation.