WHAT IS A URETHRAL STRICTURE?
Urethral stricture is a narrowing of the urethra or external pee pipe, which is the tube that carries urine from the bladder out of the body when we urinate. This issue is more commonly seen in men. The most common causes are trauma, injury, infection or inflammation which lead to circular scar formation. The original injury e.g. placement of catheters or instruments into the urethra, sometimes happens long before the stricture becomes noticeable.
Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis, but on the underside. The corrective surgery is usually done is childhood. However, as the child approaches his teens & adulthood, sometimes difficulties are encountered e.g. urethral stricture or penile curvature.
SYMPTOMS OF URETHRAL STRICTURE
Symptoms of a urethral stricture can be similar to that of prostate enlargement, including straining to urinate, poor flow, spraying of the urine stream, pain during urination, frequent urine infections, dribbling and urine retention. This is because these symptoms are related to a backlog of urine in the bladder. As the years progress and the bladder muscle deteriorates, the symptoms become related to a weakening of the bladder muscle e.g. high residual urine volumes after urination.
DIAGNOSING URETHRAL STRICTURE
Tests are essential to achieving this diagnosis. Non-invasive tests include a uroflowmetry and measurement of residual volume. We would also perform a cystoscopy using a small and narrow tube (cystoscope) to see inside the urethra and bladder. It allows the identification of any narrowing in the urethra. A special imaging procedure called a urethrogram is also performed. This is an X-ray that is done after some contrast or dye is injected into the urethra.
TREATMENTS FOR URETHRAL STRICTURE
Treatment for urethral stricture is often decided after the above tests are done. Initially a short stricture can be treated with either a Dilatation (widening) or Urethrotomy (cutting through the scar). Patients sometimes need to learn how to perform self-dilatation to keep the stricture open. If a dilatation or urethrotomy fails and the stricture recurs, then a formal Surgical reconstruction, called a Urethroplasty is advised for better long-term results with good success rates. A specialized reconstructive urologist most commonly performs this surgery because it is a very sensitive area. It is important to protect the urethra and muscles during this surgery to preserve continence and erection. Any concurrent urine infections would also need to be treated with antibiotics.