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Urethral stricture

Urethral stricture is an abnormal narrowing of the tube that carries urine out of the body from the bladder (urethra).

Causes

Urethral stricture may be caused by inflammation or scar tissue from surgery, 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.

Symptoms

Symptoms include:

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:

Treatment

The urethra may be widened (dilated) during cystoscopy. 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. Surgical options 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 cases of sudden urinary retention, a suprapubic catheter may be placed as 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.

Outlook (Prognosis)

The outcome is often excellent with treatment. Sometimes, treatment needs to be repeated to remove scar tissue.

Possible complications

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.

Prevention

Practicing safer-sex may decrease the risk of getting STIs and urethral stricture.

Treating urethral stricture quickly may prevent kidney or bladder complications.

References

Augenbraun MH, McCormack WM. Urethritis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 109.

Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010 Apr 1;81(7):873-8. PMID: 20353145

Jordan GH. McCammon KA. Surgery of the penis and urethra. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 36.

Updated: 9/29/2014

Scott Miller, MD, urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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