URETHRAL STRICTURE

Overview

A urethral or urinary stricture is an area of hardened tissue that narrows the urethra, sometimes making it difficult to urinate. Urethral strictures can occur from scarring, trauma or infections.

Strictures obstruct the flow of urine from the bladder, so the bladder must work harder to push the urine through the narrowed area.

If a stricture returns after two or more treatments, it is considered a recurrent stricture. Recurrent bulbar urethral strictures (RBUS) are a common problem for men who have undergone surgical prostate treatments, experienced repeated urinary catheterization, pelvic trauma or urinary tract infections.

Physiology

The urethra is the tube that carries urine from the bladder through the penis to the outside of the body. Urethral strictures can occur anywhere along the urethra, and they reduce the diameter of the urethra. When the stricture is located in the widest area of the urethra, the bulbous urethra, it is referred to as a bulbar urethral stricture.

Causes

Several factors can lead to the development of urethral strictures in men. Bulbar urethral injury from either urethral catheterization or instrumentation is the leading cause of strictures. Additional causes of urethral strictures include:

- Frequent urinary tract infections

- Sexually transmitted diseases

- Trauma from penetrating or blunt injuries

- Surgical procedures that cut through the urethra

- Deformities existing at birth

Signs of urethral stricture

For many men, the first sign of urethral stricture is that you may notice a reduced urinary stream. Sometimes it will be diagnosed when a healthcare provider is unable to insert a urinary catheter when required.

Common symptoms of urethral strictures include:

- Trouble beginning to urinate

- Irritating and painful burning sensation during urination

- Voiding (emptying the bladder) requires extra time

- Sensation of incomplete emptying of the bladder

- Frequent need to urinate during the day and at night

- Overflow incontinence (continued leakage of urine because bladder is full beyond capacity)

Effects

If a stricture is not treated, the increased strain on the bladder can weaken the bladder muscle. The combination of a narrowed urethra and a weakened bladder can lead to several serious problems:

Urine Retention: Inability pass urine

Urinary Incontinence: Involuntary loss of urine

Reflux: Urine backing up into the kidney

Kidney Failure: The kidney no longer excretes urine or functions normally

Damage to Bladder Muscles: The bladder muscles can become permanently weakened

Treatment

Several treatment options are available for men with urethral strictures:

Catheterization: A thin tube, called a catheter, can be inserted through the urethra into the bladder to drain the urine. This treatment option requires the catheter to be re-inserted on a regular basis.

Dilation: A metal rod, or dilator, is inserted into the penis until it reaches the strictured area of the urethra. The dilator gradually stretches the strictured area open. This process usually involves periodic treatments with progressively larger dilators.

Balloon Dilation: A balloon catheter is inserted into the urethra and inflated at the point of the stricture. This process usually involves periodic re-treatment with progressively larger balloons.

Urethral stent: Men with recurring bulbar urethral strictures who do not wish to undergo surgery or are not good surgical candidates may find immediate relief from a urethral stent like the UroLume® Urethral Stent from AMS. The UroLume is a mesh tube that holds the urethra open at the point of obstruction. It not only relieves the obstruction, it also minimizes the recurrence of strictures. The stent is placed through the urethra in an outpatient procedure.

Surgery: Two types of invasive surgery, which often require the use of general anesthesia, can be used to relieve recurrent urethral strictures. Urethrotomy involves cutting through the urethral tissue in an attempt to excise the stricture. Urethroplasty severs a section of the urethra in an attempt to remove the strictured area of the urethra. The two remaining sections of the urethra must then be surgically reconnected, and in some cases a skin graft also is required.

Seeing a Physician

The first step is to discuss the condition with a Urologist, a physician who specializes in the diagnosis and treatment of diseases of the urinary tract and urogenital system.

Common Tests

Your doctor may perform the following kinds of tests to establish a diagnosis for
urethral strictures:

Urethroscopy: With a narrow instrument that is inserted into the urethra, your physician can visually inspect the urethra, looking for obvious areas of strictures.

Uroflowmetry: A mechanical measurement of urine output and flow rate.

Urinalysis: Examines urine for signs of infection, blood, or other abnormalities

Retrograde Urethrogram: This involves injecting a contrast agent into the urethra so that strictures will show up more distinctly on an X-ray.

A Urologist will evaluate treatment frequency to determine the severity of stricture formation and the need for alternative treatments. In the majority of cases, strictures are treatable with a single procedure. However, some strictures do have a tendency to come back repeatedly. This means a single treatment may not be a permanent solution.

Urethral Stricture information from
www.AmericanMedicalSystems.com

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