Urethral stricture can be
Acquired
Anything that damages the urethral epithelium or corpus spongiosum can cause acquired stricture (1 General reference Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can... read more ).
Common causes include
Trauma
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
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 Obstructive Uropathy Obstructive uropathy is structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy). Symptoms, less likely in chronic obstruction... read more (eg, weak urinary stream, hesitancy, incomplete emptying), or recurrent urinary tract infections Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more (including prostatitis Prostatitis Prostatitis refers to a disparate group of prostate disorders that manifests with a combination of predominantly irritative or obstructive urinary symptoms and perineal pain. Some cases result... read more ).
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.
