Urethral stricture
Urethral stricture is an abnormal narrowing of the urethra. The urethra is the tube that carries urine out of the body from the bladder.
Causes
A urethral stricture may be caused by swelling or scar tissue from surgery. It can also occur after an infection 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)
Cystoscope
Cystoscopy is a surgical procedure. This is done to see the inside of the bladder and urethra using a thin, lighted tube.
Read Article Now Book Mark Article -
Benign prostatic hyperplasia (BPH)
Benign prostatic hyperplasia
The prostate is a gland that produces some of the fluid that carries sperm during ejaculation. The prostate gland surrounds the urethra, the tube th...
Read Article Now Book Mark Article - Injury to the pelvic area
- Repeated urethritis
Urethritis
Urethritis is inflammation (swelling and irritation) of the urethra. The urethra is the tube that carries urine from the body.
Read Article Now Book Mark Article
Strictures that are present at birth (congenital) are rare. The condition is also rare in women.
Symptoms
Symptoms include:
-
Blood in the semen
Blood in the semen
Blood in the semen is called hematospermia. It may be in amounts too small to be seen except with a microscope, or it may be visible in the ejaculat...
Read Article Now Book Mark Article - Discharge from the urethra
- Bloody or dark urine
Dark urine
The usual color of urine is straw-yellow. Abnormally-colored urine may be cloudy, dark, or blood-colored.
Read Article Now Book Mark Article - Strong urge to urinate and frequent urination
Frequent urination
Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, strong need to urinate. This causes a discomfort i...
Read Article Now Book Mark Article -
Inability to empty bladder (urinary retention)
Inability to empty bladder
Decreased urine output means that you produce less urine than normal. Most adults make at least 500 milliliters of urine in 24 hours (a little over ...
Read Article Now Book Mark Article - Painful urination or difficulty urinating
Difficulty urinating
Difficulty starting or maintaining a urine stream is called urinary hesitancy.
Read Article Now Book Mark Article - Loss of bladder control
- Increased frequency or urgency to urinate
- Pain in the lower abdomen and pelvic area
- Slow urine stream (may develop suddenly or gradually) or spraying of urine
- Swelling of the penis
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:
-
Cystoscopy
Cystoscopy
Cystoscopy is a surgical procedure. This is done to see the inside of the bladder and urethra using a thin, lighted tube.
Read Article Now Book Mark Article - Postvoid residual (PVR) volume
- Retrograde urethrogram
- Tests for chlamydia and gonorrhea
Chlamydia
Chlamydia is an infection caused by the bacteria Chlamydia trachomatis. It is most often spread through sexual contact.
Read Article Now Book Mark ArticleGonorrhea
Gonorrhea is a common sexually transmitted infection (STI).
Read Article Now Book Mark Article -
Urinalysis
Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
Read Article Now Book Mark Article - Urinary flow rate
-
Urine culture
Urine culture
A urine culture is a lab test to check for bacteria or other germs in a urine sample. It can be used to check for a urinary tract infection in adults...
Read Article Now Book Mark Article
Treatment
The urethra may be widened (dilated) during cystoscopy. Topical 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. The type of surgery will 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. One procedure uses a drug-coated balloon, which is inserted and opened up to dilate the urethra and deliver the medicine to the area. After several minutes, the balloon is deflated and removed. The medicine helps the stricture remain open.
A surgery called 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 acute cases when you cannot pass urine, a suprapubic catheter may be placed. This is an emergency treatment. This allows the bladder to drain through the abdomen.
Suprapubic catheter
A urinary catheter is a tube placed in the body to drain and collect urine from the bladder.
Read Article Now Book Mark ArticleThere are currently no drug treatments for this disease. If no other treatments work, a urinary diversion called an appendicovesicostomy (Mitrofanoff procedure) or another type of surgery may be done. This lets you drain your bladder through the wall of the abdomen using a catheter or a stoma bag.
Outlook (Prognosis)
The outcome is often excellent with treatment. Sometimes, treatment needs to be repeated to remove scar tissue.
A 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
Contact your health care provider if you have symptoms of urethral stricture.
Prevention
Practicing safer sex may decrease the risk of getting STIs that may cause a urethral stricture.
Treating urethral stricture quickly may prevent kidney or bladder complications.
References
Babu TM, Urban MA, Augenbraun MH. Urethritis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 107.
Elder JS. Obstruction of the urinary tract. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 555.
Virasoro R, Jordan GH, McCammon KA. Surgery for benign disorders of the penis and urethra. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 82.
Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral stricture disease guideline amendment (2023). J Urol. 2023;210(1):64-71.Epub 2023 Apr 25. PMID: 37096574. pubmed.ncbi.nlm.nih.gov/37096574/.
-
Female urinary tract - illustration
The female and male urinary tracts are relatively the same except for the length of the urethra.
Female urinary tract
illustration
-
Male urinary tract - illustration
The male and female urinary tracts are relatively the same except for the length of the urethra.
Male urinary tract
illustration
-
Female urinary tract - illustration
The female and male urinary tracts are relatively the same except for the length of the urethra.
Female urinary tract
illustration
-
Male urinary tract - illustration
The male and female urinary tracts are relatively the same except for the length of the urethra.
Male urinary tract
illustration
Review Date: 7/4/2022
Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 09/20/2023.