What is a stricture?
Urethral stricture is a narrowing of the urethra (the tube through which you pass urine) usually through scarring.
They are more common in men than women, and can cause considerable to distress to the sufferer. One of the most important issues with stricture disease is that 30-40% are recurrent – that is, they return over weeks, months or years.
What causes a stricture?
Strictures can be caused by:
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Trauma e.g. pelvic fracture (very common in motor bike accidents).
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Infection – especially gonorrhea.
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Surgical procedures.
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Catheterization – i.e. when an indwelling catheter is placed through the urethra into the bladder – a stricture very rarely occurs unless a Latex catheter is used.
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Congenital – i.e. you are born with it.
In many instances no cause for the stricture is ever found.
What are the symptoms?
Symptoms usually do not develop until the stricture is quite advanced (that is the urethral tube has been narrowed significantly), so many men have few symptoms in the early stages.
Some of the more common symptoms include:
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A slow stream.
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A urinary stream that “sprays” or “splits” – many men sit down to pass urine when they have a stricture because of this issue.
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Dribbling urine after apparently completing the passing of urine.
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A feeling of “burning” when urine is passed
What tests are needed?
The following may be used in diagnosing the presence of urethral stricture:
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Urethroscopy – a telescopic inspection of the urethra (the bladder is usually inspected too). The stricture is often treated at the same time. This is regarded as the best and simplest test because of the ability to provide simultaneous treatment of the problem.
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Urethrogram – a small catheter is placed into the end of the urethra and contrast injected. This outline the length & tightness of the stricture – no treatment is possible.
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Ultrasound – strictures can often be visualized using ultrasonography. Not often used as the benefits of this test are only for very few patients.
How is a stricture treated?
Treatment options for urethral stricture disease are varied and selection depends upon the length, location and degree of scar tissue associated with the stricture.
Strictures have a tendency to recur. The time to recurrence may vary from a few weeks to several years. There are no predicting factors. Many Urologists regard “urethroplasty” as the definitive therapy for strictures.
Options for the treatment of urethral strictures include:
Urethral Dilation
This technique involves the passage of a series of increasingly wide dilators (specially designed metal instruments for this purpose). It is often only a temporary therapy.
Self-Catheterisation
This is a method that aims at molding any new scar formation in an “open” position so as not to cause obstruction. After being taught how to catheterize, the sufferer uses a decreasing regime over a 3-4 month period- usually starting with daily catherisation for a month and decreasing thereafter.
Visual Urethrotomy
In this technique a special cystoscope (telescope) is passed into the urethra to visualize the stricture. The instrument has a small cutting blade integrated into the system that allows division of the scarred area, thus relieving the obstruction. Often a catheter is left in for a number of days after discharge.
Urethral Stent
In some circumstances, after the stricture has been opened via visual urethrotomy a stent is left in place to hold the area open whilst healing occurs. The stent is essentially an internal catheter (just like a heart stent) and can be made of a special metal or alternatively, a silastic-based compound. Stent are usually left in place for 3-6 months and then removed.
Urethroplasty
This is formal surgery to correct the strictured area of the urethra. This type of surgery can range from the simple excision of the strictured area followed by anastomosis (re-joining the two cut ends) to complex operations involving grafting of the urethra requiring a number of operations over many months.