Urethral Stricture: What Are the Symptoms and How Is It Treated with Urethroplasty?
A thin, weak urinary stream and straining can be signs of urethral stricture. Why does it occur, why does internal urethrotomy recur, and why is urethroplasty the most durable option?
Urethral stricture is a narrowing of part of the urethra — the channel through which urine leaves the body — by scar tissue. Its most obvious result is a progressively weaker urinary stream and difficulty urinating. Most men attribute these complaints to age or the prostate; yet the underlying cause may be a urethral stricture, and making this distinction correctly is critical for treatment.
What are the symptoms of urethral stricture?
- Thinning and weakening of the urinary stream (the flow is no longer as strong as before)
- Difficulty starting urination, straining to void
- A split or spraying stream
- A sense of incomplete bladder emptying, dribbling
- Frequent urination, recurrent urinary tract infections
Because these symptoms progress slowly, most patients delay for a long time. Yet an untreated stricture can lead to problems that affect the bladder and even kidney health.
Why does urethral stricture occur?
The main causes are previous urethral inflammation (including some sexually transmitted infections), trauma such as a straddle injury or accident to the perineum, previous urinary catheters or endoscopic procedures, and, in some cases, processes of unclear cause (idiopathic). Whatever the cause, the common result is scar tissue that narrows the channel.
How is it diagnosed?
Assessment uses a urine flow test (uroflowmetry), measurement of residual urine in the bladder, imaging that shows the site and length of the stricture (urethrography) and, where needed, endoscopic examination. The two most important pieces of information for the treatment plan are the site and length of the stricture; accurate mapping is therefore essential.
Why does internal urethrotomy often recur?
Internal urethrotomy (DVIU), in which the stricture is cut open endoscopically, can work in short, well-selected strictures. However, in long, recurrent or heavily scarred strictures the cut area tends to narrow again with new scar tissue. Repeating the same procedure many times often deepens the scar and makes a durable repair harder. That is why, in recurrent strictures, choosing the right method from the outset is important.
What is urethroplasty, and why is it considered the most durable option?
Urethroplasty is the open surgical repair of a urethral stricture and, in suitable cases, is accepted as the method with the most durable outcome and the lowest recurrence rate. It has two basic approaches: in short strictures, removing the narrowed segment and joining the healthy ends; in longer strictures, widening the channel with a graft prepared from the patient's own tissue (for example, buccal mucosa from the inside of the cheek). With correct patient selection and experienced surgery, urethroplasty offers a markedly lower recurrence rate and a more durable outcome than repeated procedures. Method selection is individualised according to the site and length of the stricture and the patient's condition.
When should you see a doctor?
If there is a marked weakening of the urinary stream, straining to void or recurrent urinary tract infections, you should not wait for assessment. Early diagnosis limits both progression of the stricture and the load on the bladder, and may allow less invasive solutions.
Assoc. Prof. Zülfü Sertkaya practises in the field of urology and andrology in Istanbul; urethral stricture assessments are carried out with individualised planning and full confidentiality.