Urethral stricture is scarring that obstructs the anterior urethral lumen.
Urethral stricture can be
Acquired
Anything that damages the urethral epithelium or corpus spongiosum can cause acquired stricture (1).
Common causes include
Trauma
Sexually transmitted infections such as gonorrhea
Unknown causes (idiopathic strictures)
Trauma, the most common cause, may result from a straddle injury or, occasionally, an iatrogenic injury (eg, after traumatic endoscopy or catheterization).
Less common causes include
Urethritis (usually chronic or untreated)
Malignancy (urethral cancer)
General reference
1. Wessells H, Angemermeier KW, Elliott S, et al: Male urethral stricture: American Urological Association guideline. J Urol 197(1):182-190, 2017. doi: 10.1016/j.juro.2016.07.087
Symptoms and Signs of Urethral Stricture
Symptoms may not develop until the urethral lumen has been decreased considerably. Strictures may cause a double urine stream, obstructive voiding symptoms (eg, weak urinary stream, hesitancy, incomplete emptying), or recurrent urinary tract infections (including prostatitis).
A urethral diverticulum may develop, sometimes accompanied by abscess formation and, rarely, a fistula with extravasation of urine into the scrotum and perineum.
Diagnosis of Urethral Stricture
Retrograde urethrography or cystoscopy
Urethral stricture is usually suspected when urethral catheterization is difficult. It should also be considered in males with gradual onset of obstructive symptoms or recurrent urinary tract infections, particularly if they have risk factors or are young.
Diagnosis of urethral stricture is usually confirmed by retrograde urethrography or cystoscopy.
Treatment of Urethral Stricture
Dilation or internal urethrotomy
Self-catheterization
Open urethroplasty
Treatment is determined by the type of urethral obstruction. Often, dilation or endoscopy (internal urethrotomy) is done. However, with certain types of strictures (eg, complicated strictures, such as very long or recurrent strictures or strictures that persist despite initial treatments), dilation and endoscopy should be avoided; daily self-catheterization may be indicated.
Open urethroplasty may be indicated if the stricture is localized and causes recurrent problems. This surgery often involves the use of oral mucosal graft or use of non–hair-bearing skin graft.
