Urethral Stricture Disease
Overview
Urethral stricture disease is a condition in which scar tissue within the urethra results in the urethra becoming narrower. This stricture can restrict the flow of urine and lead to various urinary tract issues, such as infections and inflammation.
Urethral stricture disease can occur due to a variety of different causes. Often, it is a result of previous medical procedures. Medical scopes and instruments are sometimes inserted through the urethra for endoscopy or procedures on the bladder or prostate. Catheter use can also be a contributing factor.
Essentially any injury to the urethra can result in a urethral stricture, including physical injury, cancer, sexually transmitted infections, or other conditions.
Symptoms
Urethral stricture shares many common symptoms with various other urinary tract issues, which can sometimes make it difficult to recognize. Common symptoms can include:
- Reduced urine stream
- Incomplete bladder voiding
- Difficulty urinating
- Urinary tract infections
- Frequent urge to urinate
Diagnosis
The process of diagnosing urethral stricture will generally entail a series of tests that first eliminate other, more common conditions. A urine test will allow the physician to check for infections, cancer, and other conditions.
A urinary flow test gives the physician further insight into the extent of the restriction on urination. Ultrasound can be used to look at the entire urinary tract and check for a variety of conditions. An ultrasound will generally reveal the extent of the urethral stricture.
Further testing can include several different imaging tests to identify the cause of or complications arising from urethral stricture. That could consist of an X-ray of the urethra or an MRI of the pelvic region.
Treatment
There are several different treatment options for urethral stricture and its symptoms. In some cases, catheterization may be necessary to allow for more effective urination. This could be a temporary or permanent measure.
Urethral dilation is sometimes effective. The physician progressively inserts larger dilators into the urethra, allowing for the urethra to be expanded in size over time.
Surgery
There are two primary types of surgery for alleviating urethral stricture. A urethroplasty removes or enlarges the narrow portion of the urethra and requires reconstruction from other tissues. Urethrotomy entails the insertion of instruments into the urethra to remove the stricture, sometimes using a laser. This method is less invasive but has a higher chance of recurrence than urethroplasty.
DVIU (Direct Visual Internal Urethrotomy)
Direct Visual Internal Urethrotomy or DVIU is a minimally invasive procedure used for the treatment of more dense blockages of the urethra from scar tissue. These scars can arise from prior radiation, trauma or even infections. It is an outpatient procedure performed under anesthesia. Your doctor using a cystoscope will visualize the scar and employ either a small blade or laser to carefully cut the affected area, opening the urinary passage way. A temporary bladder catheter is placed at the end to aid in recovery and minimal transient blood or burning in the urine is expected. It is important to let your doctor know about any blood thinners you are taking.
Dilation
Urethral dilation is a minimally invasive procedure indicated for the treatment of urethral stenosis (narrowing) or stricture (scar tissue) causing blockage of the urinary passage out of the bladder. It is typically done with minimal anesthesia while your doctor uses special instruments to slowly and carefully stretch the affected area. Often times, a temporary bladder catheter is placed at the end to aid in recovery. Minimal and transient blood or burning in the urine after the procedure is normal.
FAQ's
The most significant contributing factors are surgery to the urethra, injury, and catheterization. Additional risk factors that increase the chance of developing urethral stricture include a history of sexually transmitted infection, urinary tract infections, benign prostatic hyperplasia, and injuries to the pelvic area.
Yes, there are both posterior and anterior urethral strictures. Posterior urethral strictures occur near the start of the urethra, close to the bladder. They can result from internal pelvic injuries. Anterior urethral strictures happen near the end of the urethra.
The condition is common in patients who undergo self-catheterization. In these cases, patients must be careful to use an appropriately sized catheter and the appropriate lubrication.