Urethral Stricture Disease

Urethral stricture results from inflammation or injury to the urethra. This results in scarring and narrowing of the urethra. The most common injuries that can damage the urethra include medical instrumentation, tumor (rare), radiation therapy, pelvic fracture, and straddle injury. The most common infections that cause stricture are sexually transmitted infections, such as gonorrhea and chlamydia.

Urethral strictures can be asymptomatic or can cause numerous symptoms, which range from mild to severe. The most common symptoms from urethral stricture include weak stream, dribbling, straining, and incomplete emptying. Urethral strictures can also cause complications, like urinary retention, urinary tract infection, and epididymorchitis (infection of testicle).

Some of the possible symptoms and complications include:

Treatment options for urethral stricture disease vary depending on the length, location, and degree of scar tissue associated with the stricture.

An initial urethrotomy (cutting the stricture using a telescope) or a dilation (stretching with rods/balloon dilator) should be considered in all patients with a urethral stricture. This procedure may be done either under a local or a general anesthetic. The aim is to widen the stricture without causing additional scarring. The long-term cure for dilation is less than 20%. Most strictures will gradually narrow again in a few months. Shorter strictures (<1 cm) have a high chance of a cure with dilation/urethrotomy. Repeat dilation/urethrotomy is discouraged as it increases scarring and stricture length with each intervention.

Surgical repair is another option that your physician may explore. An open urethroplasty may be performed for longer, more severe strictures. A reconstructive procedure (urethroplasty) gives the best chance of cure from a urethral stricture. The type of surgery depends on the length and location of the stricture. In some, the area of scarring is removed and the remaining urethra is reconnected. In others, after the scar tissue is removed, a graft from inside the cheek (buccal mucosa) or a skin flap may be used to form a reconstructed urethra. Although these procedures are more invasive, they have a great cure rate (>80%) and studies have shown that the results are durable over many years.

The urologists at MedStar Health perform complex reconstructive surgeries for treatment of urethral strictures.