Urethral Stricture

The Link Between Urethral Stricture and Urinary Tract Infections

The urethra is a tube that transports pee from the bladder to the outside. The urethra is usually wide enough to allow urine to flow freely through it. It can restrict urinary flow when the urethra narrows. We know it as a urethral stricture. The medical ailment of urethral stricture primarily affects men. Many men with strictures will experience increased urination, discomfort, and a slowdown in the urine stream. It may develop over time, requiring force or strain to get the urine out. Others will be struck with the disease unexpectedly and without warning, demanding prompt medical attention. Through the urethra, the bladder empties and exits the body (called "voiding"). In males, urine from the bladder must travel a longer distance through the penis. In males, the posterior urethra is the passageway through which urine flows.

A team of Urologists

What are the causes of urethral stricture?

When the urethra constricts, urine strangulation ensues. Scar tissue or tissue inflammation causes urethral stricture. Scar tissue can develop as a result of a variety of factors. Men with penile implants have a higher chance of developing urethral stricture. A typical type of trauma that can cause urethral stricture is a straddled injury. Falling on a bicycle bar or being injured in the area near the scrotum are examples of straddled injuries. Other causes of urethral stricture include pelvic fractures.

• Catheter insertion
• Prostate radiation treatment.
• The sickness, benign prostatic hyperplasia (BPH), occurs when the prostate gland grows too quickly.
• Untreated or recurrent urinary tract infections, sexually transmitted infections (STIs), 
• Gonorrhea, or chlamydia, are all rare causes.

What are the risk factors for urethral stricture?

Some male patients have an elevated risk of developing urethral stricture, especially those who have

• Sexually transmitted infections.
• A recent catheter placement
• Urethritis 
• An enlarged prostate

What are the symptoms of urethral stricture?

Urethral strictures can cause many symptoms, ranging from mild to severe. Some signs of urethral stricture include:

• A reduction in urine volume or a weak urine flow
• The urge to urinate frequently
• sense of incomplete bladder emptying after urination.
• While urinating, you may experience pain or a burning sensation.
• Inability to keep urinating under control (incontinence)
• Pelvic or lower abdominal discomfort
• Penile swelling
• Penile swelling and pain 
• discharge of blood or sperm from urine.
• Darkening of urine 
• inability to urinate (this is a life-threatening condition that requires emergency medical intervention).

How do urologists diagnose urethral strictures?

Surgeons may use several approaches to diagnose urethral stricture. Your doctor may also ask about past illnesses and medical procedures to determine whether one or more risk factors are present.

How do urologists perform a physical examination?

A simple physical examination of the penis area can help them identify a urinary stricture. For instance, the doctor observes urethral discharge and if one or more regions are solid or swollen. 

How do urologists conduct the tests?

Urologists may measure the rate of flow during urination. Urosurgeons may choose to undertake one or more of the following tests to confirm a definitive diagnosis of urethral stricture:

• They may analyze the physical and chemical properties of urine. 
• They may decide if bacteria (or blood) is present.
• Cystoscopy: Urologists may insert a small tube to view the inside of the bladder and urethra (the most direct way to check for stricture).
• Urologists may measure the size of the urethral opening.
• They may test for chlamydia and gonorrhoea.

How is urethral stricture treated?

Many options depend on the size of the blockage and the intensity of the scar tissue. 

Surgical treatments include:

• Dilation (enlarging the stricture with slow stretching)
• Cut the urethral stricture with a laser or knife through a scope.
• Open surgery or urethroplasty.
• Surgical removal of urethral stricture with reconnection and reconstruction, possibly with grafts.

There is no available readymade medicine to treat strictures. Without treatment, you will continue to have problems with voiding. Urinary and testicular infections and stones could develop. There is a risk of urinary retention (when you can't pass urine), which leads to an enlarged bladder and kidney problems.

What is the dilation technique in urethral stricture treatment?

Surgeons frequently perform under a local anaesthetic in a urologist's office. Dilation is an outpatient procedure that involves passing a wire across the stricture and progressively stretching the aperture with larger and larger dilators. Following this therapy, urologists will place a catheter in your bladder for a few days. Dilation is a temporary, non-curative management technique.

What is urethrotomy?

Surgeons achieve a direct view of the stricture. To avail of this facility, doctors have to use a cystoscope (fiberoptic camera) up to the stricture point. It passes through a blade to cut open the scar tissue and recreate a wide opening in the urethra. Surgeons have to place a catheter for one week. 

• The patient will get cuts or stitches in the skin. 
• Urethrotomy is most effective for very short strictures, less than one centimetre long. 
• Potential side effects include bleeding, infection, stricture recurrence, urine leakage, and erectile problems.

What is urethroplasty in urethral stricture treatment?

There are different reconstructive options to remove the stricture and recreate the urinary tube. Surgeons consider this open surgical procedure the gold standard for stricture correction. 

• Long-term success rates for urethral reconstruction range from 80 to 95 per cent 
• Urologists perform such procedures in two to three hours for outpatient procedures.
• They require a urethral catheter for four weeks.
• Urologists removed a section of the scarred urethra, and after that, they sewed the two ends back together.

Anastomotic urethroplasty has a success rate of 90-95 per cent.

What is substitution graft urethroplasty?

We use substitution graft urethroplasty for longer strictures greater than two centimetres and penile urethra scar tissue. Urologists use mouth grafts to reconstruct the urethra by patching the damaged area and increasing the tube size. Long-term success is estimated to be between 80 and 85 per cent.

What is staged urethroplasty?

Staged urethroplasty is a research technique used for the worst strictures. Doctors employ it for urethras that get damaged for virtually the entire length. The staged urethroplasty option involves multiple staged surgeries before the urethra for total repair. 

What is the perspective of urethral stricture?

Urethral stricture has a positive outcome. It is a treatable condition. However, this condition can recur again, requiring multiple procedures.