A urethral stricture is caused by a scarred change in the urethra. It manifests itself in increased urinary tract infections and an altered urinary stream. Men are more frequently affected than women, as the urethra is significantly shorter in women. Urethral stricture requires early treatment as it can severely restrict quality of life. Various treatment options are available.
Below you will find further information and selected specialists for urethral strictures.
The most important symptom of urethral stricture is an altered urinary stream. For example, the stream may be weaker than usual, but it may also change its direction or shape. In addition, those affected often have to consciously push when urinating, which is not necessary under normal circumstances.
There is also often a delay in urination, as the urine first has to pass through the constriction. Afterwards, some urine may remain in the bladder, which is also known as residual urine formation. Together with the reduced urine flow, this increases the risk of urinary tract infections.
In addition, urethral stricture can lead to the following symptoms:
In severe cases, the narrowing can be so severe that the urethra is completely blocked and urinary retention occurs. This leads to severe pain and the urine backs up to the kidney. This back-up can cause life-threatening kidney failure, which is why immediate treatment is necessary.
In summary, the following symptoms are the most common:
There are various causes of urethral stricture:
In just under 30 percent of cases, no cause for the narrowing of the urethra can be found. Doctors then speak of idiopathic urethral stricture.
If urethral stricture is suspected, a urologist, a specialist in diseases of the urinary tract, is the right person to consult.
He or she will first take the patient's medical history and then carry out a number of examinations. During the physical examination, the doctor will try to identify external causes for the narrowing. A urine test is also recommended to rule out urinary retention.
The doctor checks the urine flow with a uroflowmeter. This involves the patient urinating into a toilet with a full bladder, which measures the flow of urine.
If there is a narrowing of the urethra, urination will take longer and the urine stream will be weaker than normal. This examination reveals typical changes in urine flow.
The doctor then uses ultrasound to check whether there is urine in the bladder. He also assesses the condition of the bladder and kidneys.
If the examinations confirm the suspicion of a urethral stricture, the type, length and position are determined.
The doctor will carry out the following procedures:
In retrograde urethrography, the doctor injects a contrast agent into the urinary tract. In anterograde urethrography, the contrast agent is introduced into the urinary bladder through a urethral catheter or through the abdominal wall. The doctor uses the X-ray image to check the narrowing.
Alternatively, a urethroscopy is performed , during which the doctor examines the urethra with a camera. This is attached to an endoscope.
However, it can happen that the stethoscope cannot pass through the constriction. In this case, the doctor is unable to determine the length of the narrowing.
The urologist is the right person to contact if you have a urethral stricture @ Pixel-Shot /AdobeStock
Urethral stricture can be treated in different ways, depending on the length and location of the stricture. Treatment can be conservative or surgical.
Which treatment option is suitable depends on the location and size of the narrowing. It also depends on whether treatment has already taken place.
Bougienage or dilation is the oldest treatment method for urethral stricture. Doctors insert a special catheter into the urethra to dilate it.
However, the effect of this treatment does not last long. This is why the dilatation must be carried out repeatedly. The urethral strictures (recurrences) that occur afterwards are often longer than the previous narrowing.
The method is suitable for people who do not want an operation or for whom the risk of anesthesia is too high. Conventional dilation procedures result in recurrent strictures in 80% of cases, which become longer over time.
In this procedure, doctors use an endoscope to insert a stent into the narrowing. This is a small tube that keeps the urethra open.
There are stents that remain in the urethra and those that have to be replaced after several months. This can lead to further scarring and therefore aggravate the situation. It is therefore only used in exceptional situations.
An endoscope can be used to insert a stent at the site of the urethral stricture @ Özgür Güvenç /AdobeStock
In this procedure, doctors insert a drug-coated balloon catheter into the urethra. At the affected site, they gently inflate the balloon to deliver the drug (paclitaxel) to the surrounding tissue.
This procedure gently expands the stricture. As a chemotherapeutic drug, paclitaxel inhibits the formation of new cells. This reduces the recurrence of the strictures.
According to current studies, this dilatation procedure is superior to conventional dilatation procedures. It is a minimally invasive treatment procedure.
In this method, doctors incise the stricture endoscopically with a knife or laser to widen the narrowing. As with conventional dilatation procedures, there is also a risk of recurrence.
A slit should not be made more often, as the narrowing causes injury to healthy tissue. This increases the size of the stricture.
In the case of a short urethral stricture, the surgeon cuts the narrow section out of the urethra . He then sutures the two ends directly together. Doctors refer to this procedure as an end-to-end anastomosis.
If the constriction is long, an operation with subsequent urethral replacement, known as graft urethroplasty, is an option. Doctors often use foreskin or oral mucosa to reconstruct the section that has been cut out.
This treatment requires sufficient experience in this area in order to avoid complications such as new strictures and fistula formation.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
