Urethral stricture symptoms include decreased urine stream and frequent urination. A urethral stenosis is a narrowing of the urethra, also called the urethra (or urethra). This narrowing occurs when part of the urethra narrows. Any part of the urethra can be affected. There is usually scar tissue around the affected part of the urethra where the stricture is present. The length of strictures varies from less than 1 cm to the entire length of the urethra. With urethral stricture there is often a complication of inflammation or injury, called post-infectious urethral stricture and post-traumatic urethral stricture respectively. After treatment of the urethral stricture, the complaints are often resolved. The prognosis is favorable.
- Urethra or urethra
- Urethra in men
- Urethra in women
- What is a urethral stricture?
- Cause of urethral stricture
- Posttraumatic urethral stricture
- Post-infectious urethral stricture
- Risk factors
- Symptoms of a urethral stricture
- Consequences of a urethral stricture
- Examination and diagnosis
- Treatment of a urethral stricture
- Medicines on the day of surgery
Urethra or urethra
The urethra – also called the urethra or urethra – is the tube through which urine flows from the bladder.
Urethra in men
In men, the urethra runs from the bladder to the very tip of your genitals. The urethra begins as an opening in the bladder, then passes through the prostate, after which it passes the pelvic floor. The external sphincter (sphincter) is located in the pelvic floor and when it is damaged, (involuntary) urine loss occurs. The urethra then bends under the pubic bone to become part of your genitals. The urethra ends at the top of the glans.
Urethra in women
In women, the urethra runs from the bladder (bladder neck) to the vulva. In women, the urethra is only 2.5 to 4 cm long. The pee hole is located in the vulva, between the clitoris and the vaginal opening. This short length of the urethra makes girls and women more susceptible to infections of the bladder and urinary tract.
What is a urethral stricture?
The medical name for a urethral stricture is ‘urethral stricture’. It often occurs because scars have formed as a result of damage to the inside of the urethra. This can cause a narrowing of the urethra, making urination difficult.
Cause of urethral stricture
A urethral stricture is caused by damage to the mucous membrane that lines the inside of the urethra. This damage can occur in many ways. A distinction is often made between:
- post-traumatic urethral stricture; and
- post-infectious urethral stricture.
Posttraumatic urethral stricture
A post-traumatic urethral stricture is often caused as a result of a traffic accident or a fall. For example, if you fell hard on the bar of your bicycle as a child. Medical procedures such as placing a catheter before surgery and endoscopy can also damage the urethra. Damage to the mucous membrane may thus occur, after which scar tissue forms due to ischemia (reduced blood supply). The urethra narrows and a so-called ‘stricture’ forms.
Post-infectious urethral stricture
Post-infectious urethral stricture is when a urethral stricture occurs as a result of an untreated (adequately) infectious disease of the reproductive organs, such as gonorrhea, chlamydia and syphilis. The urethra can become infected and inflamed, causing scarring and possibly a narrowing of the urethra. However, the cause of urethral stricture is not always known.
Factors that increase the risk of urethral stricture include:
- sexually transmitted infections (STDs)
- a catheter
- undergo cystoscopy
- urethritis or urethral inflammation (swelling and irritation in the urethra), possibly due to infection
- an enlarged prostate
Symptoms of a urethral stricture
Initially you often do not experience any complaints. At some point, the following complaints may arise, which may worsen over time:
- reduced urine flow is often the first symptom
- frequent urination (frequent urination)
- annoying urge to urinate
- inability to urinate empty (urinary retention)
- bladder infections
- a little urine loss during pressure-increasing moments, such as coughing, laughing and sneezing
- problems with erection and ejaculation
- hematuria (blood in the urine)
- dark urine
- blood in the semen
- stomach ache
- a discharge from the urethra
- a loss of bladder control (urinary incontinence)
- a swelling of the penis (swollen penis)
- pain in the lower abdomen and in the pelvic area (pelvic pain)
- painful urination or difficulty urinating
Consequences of a urethral stricture
A narrowing causes increased resistance in the urethra, making urine flow less easily. In order to maintain a good urine stream, you will contract the bladder harder, which is accompanied by pain. Your bladder muscle will also grow if you keep contracting it hard when urinating and this is called an enlarged bladder. After a few years, the bladder becomes thicker and bulges may develop, in which urine remains, which increases the risk of bladder infections. the bladder will no longer function and urination will become impossible. It is therefore important to treat a urethral stricture in a timely manner.
Cystoscopy / Source: Alexilusmedical/Shutterstock
Examination and diagnosis
A urethral stricture (and its severity) can be determined on the basis of the following examinations:
- Stream test (flowmetry), where you urinate into a funnel and a graph shows the speed of the urine stream.
- Visual examination (cystoscopy), where the urologist looks inside the urethra.
- Contrast X-ray of the urethra (retrograde urethrography), in which contrast fluid is applied to the urethra, followed by an X-ray image of the urethra and any narrowing.
Treatment of a urethral stricture
A simple deviation, i.e. not too long and not too narrow, can often be corrected by means of keyhole surgery, under anesthesia. Unfortunately, after such treatment the narrowing often returns and repeat surgery is often less successful. In the case of more extensive strictures and recurring strictures, open surgery is often chosen, in which the affected narrow part of the urethra is removed and the two healthy ends are put back together. The urethra may be repaired with pieces of skin or oral mucosa.
Medicines on the day of surgery
On the day that you are operated on for urethral stricture, you will receive medication from the nurse approximately 2 hours before the procedure. This includes a suppository to relieve pain, soothing medication in the form of tablets and an injection to reduce the risk of thrombosis. This medication may be administered before or after surgery, depending on the protocol.
Once in the operating room, an IV will be inserted to administer fluids and medications. This is to ensure that you stay well hydrated and to easily administer the necessary medication during the operation.
If surgery is not desired or possible, periodic stretching can be performed by the urologist or by the patient himself. The latter is called ‘self-catheterization’.
More pressure is required from the bladder muscle to allow urine to pass through a stricture (it acts as a bottleneck). Not all the urine in the bladder can be passed out when you go to the toilet. Some urine remains in the bladder. This remaining urine is likely to become infected. This makes you more susceptible to bladder, prostate and kidney infections. An abscess may develop above the stricture. This can cause further damage to the urethra and surrounding tissues. Cancer of the urethra (urethral cancer or urethral cancer) is an extremely rare complication of a long-standing stricture.
It is not always possible to prevent urethral stricture. Since STDs are a possible cause, using condoms during sexual activities can prevent some cases. However, injuries and other medical conditions that can cause urethral stricture cannot always be avoided.
Urethral stricture has a good prognosis after treatment. At a later stage, follow-up treatment is sometimes necessary to remove scar tissue.
- Not being able to urinate: causes of urinary retention in men and women
- Urine: difficulty urinating (urination), retention, incontinence
- Pain in the urethra: symptoms and causes of urethral pain
- Pain when urinating: causes burning sensation when urinating
- Urine or pee: abnormalities in color or amount of urine