Understanding Urethral Stricture

What is Urethral Stricture?

Urethral stricture is a medical condition characterized by the narrowing of the urethra, the tube that carries urine from the bladder out of the body. This narrowing restricts the flow of urine, causing discomfort and various complications. It can affect individuals of all ages, but it is more common in men.

Types of Urethral Stricture

Urethral strictures can be categorized based on their location and severity:

Anterior Urethral Stricture:

  • Located in the front part of the urethra, closer to the external opening.

  • Commonly caused by injury or trauma.

Posterior Urethral Stricture:

  • Found in the back part of the urethra, near the bladder.

  • Often results from pelvic fractures or surgical complications.

Short vs Long Strictures:

Short Strictures: Affect a small segment of the urethra.

Long Strictures: Extend over a larger portion of the urethra, often requiring more complex treatment.

Causes of Urethral Stricture

Several factors can contribute to the development of urethral strictures, including:

  • Trauma or Injury: Direct injury to the urethra, often from accidents or surgical procedures, can lead to scar tissue formation and narrowing.

  • Infection: Infections like urethritis or sexually transmitted infections (STIs) can cause inflammation and subsequent scarring.

  • Medical Procedures: Previous surgeries, catheterization, or radiation therapy can damage the urethra, resulting in strictures.

  • Inflammatory Conditions: Chronic inflammation of the urethra due to conditions like lichen sclerosus can lead to strictures.

  • Congenital Factors: Some individuals may be born with a naturally narrow urethra, leading to early onset of strictures.

Symptoms of Urethral Stricture

The symptoms of urethral stricture can vary depending on the severity of the narrowing, but common signs include:

  • Difficulty Urinating: A weak or interrupted urine stream is a hallmark of urethral stricture.

  • Painful Urination: A burning sensation or pain during urination is common.

  • Frequent Urination: The need to urinate more often, especially at night.

  • Urinary Retention: In severe cases, the urethra may become so narrow that it becomes difficult to empty the bladder completely.

  • Blood in Urine: Hematuria, or blood in the urine, can occur due to irritation or injury in the urethra.

  • Urinary Tract Infections (UTIs): Recurrent UTIs may develop as a result of incomplete bladder emptying.

How is Urethral Stricture Diagnosed?

Diagnosing urethral stricture typically involves a combination of medical history, physical examination, and specialized tests:

  • Medical History and Physical Exam: Your healthcare provider will review your symptoms and medical history, followed by a physical examination.

  • Uroflowmetry: This test measures the flow rate of urine to detect abnormalities in urine flow.

  • Cystoscopy: A thin, flexible tube with a camera (cystoscope) is inserted into the urethra to visualize the narrowing and assess its location and extent.

  • Retrograde Urethrogram: An X-ray test where contrast dye is injected into the urethra to visualize the stricture on an imaging scan.

  • Ultrasound or MRI: In some cases, imaging tests may be used to provide more detailed information about the structure and location of the stricture.

Treatment Options for Urethral Stricture

The treatment for urethral stricture depends on the severity, location, and underlying cause of the narrowing. Common treatment options include:

1.Dilation:

    • A procedure where the urethra is gradually widened using special instruments.

    • It provides temporary relief but may need to be repeated.

Optilume® Drug Coated Balloon Dilation

Optilume is the world’s first Drug Coated Balloon approved by the FDA to treat patients with Urethral Strictures. The Optilume Urethral Drug Coated Balloon technology simultaneously dilates and delivers an anti-proliferative medicine to the urethral stricture.

During the Optilume procedure, The Optilume device expands the scar tissue surrounding the urethral stricture creating a dilation and micro-fissures across the affected area. This allows the drug, paclitaxel, to be delivered directly to the stricture. This combined technique results in limiting scar tissue generation and helps prevent future stricture recurrence.

Optilume® is proven to provide superior results compared to the standard of care for endoscopic management. The ROBUST III Randomized Controlled Clinical Trial showed that 83% of patients remained free from re-treatments for their urethral stricture 1 year after their Optilume procedure. Our providers here at Center for Urology would be happy to assess if the Optilume would be your best treatment option. 

2.Urethrotomy:

    • A minimally invasive procedure where the stricture is cut open using a small surgical instrument inserted through the urethra.

    • It may be effective for short strictures but carries a risk of recurrence.

3.Urethroplasty:

    • A surgical procedure where the narrowed segment of the urethra is removed or reconstructed using tissue from another part of the body.

    • It is often the most effective long-term solution, especially for complex or recurrent strictures.

4.Catheterization:

  • In cases of severe stricture, a catheter may be temporarily placed to allow urine to bypass the stricture.

  • This is often used as a temporary measure before more definitive treatment.

Seeking Help

If you believe you may be experiencing symptoms of a ureteral stricture, such as pain, difficulty urinating, or other related issues, it’s important to seek medical attention promptly. Please contact the Center for Urology to schedule an appointment. Our experienced team is here to provide you with the expert care and treatment you need, and we can discuss all available treatment options to determine what’s best for you.