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Urethral Stricture

by Patrick J. Shenot, MD

Urethral stricture is scarring that obstructs the anterior urethral lumen.

Urethral stricture can be

Anything that damages the urethral epithelium or corpus spongiosum can cause acquired stricture. The most common cause is trauma, such as straddle injury and occasionally iatrogenic injury (eg, after traumatic endoscopy or catheterization). Sexually transmitted diseases such as gonorrhea may cause strictures. Less common causes may include lichen sclerosis and urethritis (usually chronic or untreated). Often strictures are idiopathic.

Symptoms and Signs

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 UTIs (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

  • Retrograde urethrography or cystoscopy

The diagnosis is usually suspected when urethral catheterization is difficult. It should also be considered in males with gradual onset of obstructive symptoms or recurrent UTIs, particularly if they have risk factors or are young. Diagnosis is usually by retrograde urethrography or cystoscopy.

Treatment

  • Varies based on type of obstruction

Treatment is determined by the type of 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.

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