Urethral Stricture

Definition/diagnostic criteria Urethral stricture involves the narrowing of the urethra due to scarring, leading to a reduction in urine flow. This scarring may be the consequence of inflammation, injury, or infection. The condition can occur at any point from the bladder to the tip of the penis and can affect both voiding and storage urinary symptoms.

Epidemiology Urethral stricture predominantly affects males and is relatively uncommon in females. It has a reported incidence of 0.6% in men, and it is more prevalent in those aged 55 years and older. The condition can be attributed to a variety of causes including trauma, infection, iatrogenic injury, or idiopathic causes.

Diagnosis

Clinical features Patients with urethral stricture may present with a range of symptoms including reduced urine stream, straining to void, spraying of the urine stream, post-void dribbling, urinary tract infections, and in severe cases, complete urinary retention. Physical examination may reveal a distended bladder and meatal narrowing.

Investigations A urethrogram can determine the location and length of the stricture. Uroflowmetry and post-void residual urine measurement via ultrasound can also aid in the diagnosis, typically showing a reduced flow rate and increased residual urine. Cystoscopy can be used for direct visualization of the stricture.

Treatment The treatment of urethral stricture aims to improve the lumen size of the urethra and involves several approaches including:

Dilation and Urethrotomy: Dilation involves stretching the stricture while urethrotomy entails making a cut in the stricture under direct vision. Both are minimally invasive but have a high recurrence rate.

Urethroplasty: This surgical procedure involves the removal of the narrowed segment of the urethra or enlargement of the narrowed area. It is generally reserved for strictures that are recurrent or not amenable to less invasive treatments.

Permanent Catheterisation: These are considered in patients who are not suitable for surgery or in those with recurrent strictures after surgery.

Prognosis The prognosis for urethral stricture is variable and largely depends on the cause, length, and location of the stricture, as well as the chosen treatment modality. Urethrotomy and dilation have higher recurrence rates, often necessitating repeated procedures. Urethroplasty, although more invasive, offers the best chance for a long-term cure.