A urethral stricture is a narrowing of the urethra, the tube that carries urine from the bladder to outside the body. It can occur several times, at any age, in any part of the urethra.
However, many more men than women suffer from it and at Somerset Urology we have the skills, knowledge and facilities to assist both genders in a private and comfortable surrounding.
Symptoms of Urethral stricture
- pain when urinating
- a weak or intermittent flow
- a urine stream that is split or comes out at an unusual angle
- an inability empty the bladder fully
- dribbling after urination
- an urge to ‘go’ more often
- kidney pain, felt in the lower back
Causes of Urethral stricture
The body’s efforts to repair damage caused by an injury or infection generates a build-up of scar tissue in the tract, narrowing or even closing the passage.
As the urethra in men is close to the skin and in a vulnerable place, just falling off a bicycle or being hit between the legs by a ball can result in the formation of scar tissue within the urethral tract. The growth of scar tissue may be painless until problems urinating are noticed.
Kidney stones forcing their way through the urethra can also lead to urethral strictures. Instruments, catheters (or anything) inserted in the urethra can also cause damage.
Urethral strictures can be caused by a viral or bacterial infection of the tract, often by certain sexually transmitted infections (STIs).
For men, a narrowing at the end of your penis is called a meatal stricture, and can be so severe that the opening becomes just a pinhole. A similar condition is meatal stenosis – repeated inflammation of the foreskin, sometimes caused by an infection of the urinary tract or by damage from an instrument or catheter.
Babies and Toddlers
Inflammation following circumcision can cause urethral strictures, often not noticed until toilet training, when straining to go or an angled or split stream is noticed.
Diagnosis of Urethral stricture
To start with your flow rate of urine will be tested. This involves measuring how much is passed per second as you pass urine. A much reduced flow rate is indicative of a stricture.
A thin telescope is inserted into the urethra to look at the stricture.
This is an X-ray examination of the urethra for men, which cannot be seen on a normal X-ray; taken whilst passing urine. A clear fluid or X-ray dye is used to outline the urethra so that the site and severity of a stricture can be seen.
Treatment of Urethral stricture
Depending on the severity of the urethral stricture, antibiotics taken at an early stage can be effective in reducing urethral inflammation. This can give some relief from straining and help the urinary stream.
If the urethra is not too narrow, it can be stretched (dilated), usually under local anaesthetic. Meatal Dilatation is a procedure which involves passing a short, soft catheter in through the end of your urethra to beyond the narrow part to keep the urethra open. This can be carried out as often as necessary, usually every three to six months depending upon the severity and position of the urethral stricture and the age and fitness of the patient.
Some men who suffer recurring urethral strictures can be taught to perform self-meatal dilatation when necessary.
In some cases it may be necessary to perform a ‘meatotomy’ – a small operation to stretch or cut through the thickened tissue in the urethra.
Circumcision (removal of the foreskin) may be necessary if repeated infections and inflammation at the tip of the penis have resulted in a tight foreskin.
Recurrent Urethral Stricture
A reduction in the flow of urine or difficulty passing the catheter into the urethra may mean the narrowing has re-occurred and it’s time to seek advice again.
Urethral Stricture Disease
Because of recurrence is extremely common, urethral stricture disease can be a lifetime-long condition, even after successful surgical intervention. Patients can be taught to recognise the symptoms of urinary tract infections (UTIs), so that they can get early treatment, and be checked annually for at least five years after surgery.
For men over the age of 40 the prostate should be regularly monitored as there could to be a slightly higher incidence of prostatitis in stricture patients.