All about Urethral Stricture Disease, Symptoms and Management

by admin-blog-kh | February 21, 2025 7:24 am

Summary

Urethral Stricture is a condition in which the urethra, which is the pipe leading the urine from the bladder to outside of the body, gets constricted or narrowed down. As a result, the urine stream is thinner and does not leave the bladder fully. This causes discomfort to the person, along with increasing the risk of urinary tract infection and other complications. The condition is treated using various methods including surgery. In this article, we will learn more.

Introduction 

The urinary system primarily consists of the kidneys which generate urine after filtering wastes and excess fluid from the blood, thin pipes called ureters which carry urine from the kidneys to the bladder, the bladder which is a temporary storage for the urine, and finally the urethra which is a thin pipe that leads the urine from the bladder to outside of the body.

Urethral stricture is a condition that affects more men than women (this could be because the urethra is shorter in a woman than it’s in a man). In this condition, scar tissue that has formed in the urethra due to one or more reasons, blocks the urethral opening partially. This makes it difficult for the person to pass urine, leading to various symptoms and complications.

Causes and Risk Factors 

• Scar tissue formation is one of the most prominent causes of urethral strictures. This can happen due to any of the following reasons:
  • Any medical procedure that involves inserting an instrument such as an endoscope into the urethra
  • Use of catheter: This is a tube that’s inserted into the urethra to drain the bladder
  • Surgery to reduce or completely remove an enlarged prostate gland
  • Radiation therapy for the cancers in bladder[2], prostate or cervix
  • An injury to your penis or scrotum such as a straddle injury to the scrotum or perineum, fracture to the pelvis from sporting injuries or vehicle collisions
• Sexually transmitted infections (STIs), especially chlamydia
• Conditions that cause inflammation: Example, lichen sclerosus – this is a skin condition that causes patchy, discoloured or white skin that often affects the pelvic area
• Had one or more instances of urethritis – swelling and irritation in the urethra due to infection
• Congenital defects: Boys born with abnormal or improperly formed genitals can develop urethral structures in childhood and later in adulthood too. For example, hypospadias is an abnormality where the urethra is not at the tip of the penis but eccentrically placed on the underside of the penis.
• Unknown causes (this accounts for as much as 30% of the cases)

Symptoms 

• Weak stream of urine
• Reduction in volume of urine
• Bladder not emptying completely
• Spraying or splaying of urine (as against a stream)
• Finding it difficult or painful to urinate, burning sensation while urinating
• Frequent passing or feeling the need to pass urine
• Urinary tract infection[3] (UTI)
• Prostatitis – inflammation of the prostate gland
• Intermittent starting and stopping of the urine stream
• Incontinence or the inability to control urination[4] (leading to leaking urine or involuntary urine discharge)
• Pain in the lower abdomen and pelvic areas
• Smelly discharge from the urethra
• Swelling and pain in the penis
• Presence of blood in the urine or semen
• Dark-coloured urine
• Dribbling – intermittent urination in drops

Complications 

• Urinary retention: In this, the person is not able to pass urine at all, as a result, the urine refluxes (goes back) into the urinary tract. This is a medical emergency which can cause kidney damage and a condition called hydronephrosis. The patient must be rushed to a hospital without any delay.
• Prostatitis: Described earlier, this is both symptom and complication.
• Urinary tract infections: Again, this is both symptom and complication.
• Bladder dysfunction: Gradual loss of bladder functionality resulting in symptoms listed earlier.
• Urethral diverticulum: An unwanted sack or pocket forms along the urethra, and fills up with urine or pus.
• Periurethral abscess: A rare condition that can be quite dangerous. Here the urethral and periurethral areas develop an infection.
• Fournier’s gangrene: A rare and dangerous infection of the genital area and perineum (the flesh between the penis and anus in a man, and between vagina and anus in a woman).
• Urethral fistula: Fistulas are abnormal connections that happen between an organ or gland and another organ, gland, tissue, blood-vessel, muscle, etc. In case of a urethral fistula, an abnormal connection develops between the urethra and the surface of the skin in the perineum.
• Bilateral hydronephrosis: Hydronephrosis is a condition in which the areas in the kidney that collect urine start swelling up, when urine is not being regularly or properly emptied from the bladder. When this happens in both kidneys, it’s called bilateral hydronephrosis[5].
• Urinary calculus: Calculus refers to abnormal particles that accumulate in some part of the body. In urinary calculus, solid particles start accumulating in the urinary stream.

Diagnosis 

• Urine tests or Urinalysis: These are a series of tests that look for infection or traces of blood in the urine.
• Urinary flow test: Here, a special toilet bowl is used to measure the urine flow and how fast it is.
• Urethral ultrasound: This shows how long the stricture is and also measures the size of the urethral opening.
• Pelvic ultrasound: This checks if there is still any urine left in the bladder after urination.

Postvoid residual (PVR) volume.

• Pelvic MRI scan: This looks for abnormalities in the pelvic bone and if it is contributing to the condition (as in the case of a pelvic bone fracture).
• Retrograde urethrogram: In this, a catheter is inserted into the urethra and a contrast dye (that is harmless) is injected into the catheter. Then using X-ray images, the doctor will look for an injury or problem in the urethra. It can also show how long the stricture is and where it is.
• Antegrade urethrogram: Similar to the above, but here, the contrast dye is inserted into the bladder. This shows if the stricture is present in the initial part of the urethra.
• Cystoscopy: A cystoscope which is a thin, tube-like tool with a lens at the end is inserted into the urethra to visualize the urethra and the bladder. This helps detect any abnormalities anywhere in the route.
• Tests for STIs like chlamydia and gonorrhoea.

Treatment 

Depending on how long is the stricture, its exact location, its type and how severe the symptoms are, one or more of the following treatment options may be used as per the urologist’s discretion.

• Endoscopic urethrotomy: As the name implies, an endoscope (cystoscope in this case) is used in the procedure. A special device is passed into the cystoscope and moved all the way to the spot of the stricture. The device can either be used to cut open the stricture altogether, or treat it with a laser.
• Urethroplasty: This is a procedure with a higher success rate. In this, the constricted part of the urethra is surgically removed or enlarged. This can involve rebuilding of the tissues around the urethra. To do so, tissues from the skin or inside of the mouth are used as graft material.
• Urethral dilation: This is an outpatient procedure done for people who have recurring urethral strictures. This gives temporary relief. This is done by using a thin wire inserted into the urethra all the way up to the bladder. Then, progressively, larger and larger dilators are passed on the wire in order to increase the size of the opening little by little.

A urethral catheter is placed after the above procedures during set periods of time as decided by the urologist[7] based on the nature of stricture.

• Implanted stent or long-term catheter: Patients who have a severe stricture and who do not want repeated surgical procedures for the same can go for this option. Here, a small tube-like stent is put into the urethra to keep it open always. Or, a permanent catheter is put in the urinary tract to drain the bladder.

For reliable diagnosis and treatment of urethral strictures, consider visiting Kauvery Hospital. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our team of skilled urologists is committed to providing personalized care and advanced treatment options to ensure optimal urinary health[8]. Trust us for comprehensive and compassionate healthcare services.

Frequently Asked Questions

What is urethral stricture disease?
Urethral stricture is a condition where the urethra narrows due to scar tissue, making it hard to pass urine.

What causes urethral strictures?
Causes include injuries, infections, medical procedures (like catheter use), surgeries, and sometimes the reason is unknown.

What are the common symptoms?
Symptoms can include a weak urine stream, difficulty emptying the bladder, pain or burning when urinating, and frequent urinary tract infections.

How is urethral stricture diagnosed?
Doctors diagnose it using urine tests, flow tests, ultrasounds, X-rays, and a procedure called cystoscopy.

What treatment options are available?
Treatments include endoscopic procedures (like urethrotomy), surgery (urethroplasty), urethral dilation, and sometimes stents or long-term catheters.

Can untreated urethral stricture cause complications?
Yes, if left untreated, it can lead to urinary retention, repeated infections, bladder dysfunction, and other serious complications.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

Source URL: https://www.kauveryhospital.com/blog/urology/all-about-urethral-stricture-disease-symptoms-and-management/

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