Urethral Stricture
What is Urethral Stricture?
Urethral stricture is an abnormal narrowing of the urethra, which makes it more difficult for urine to pass from the bladder to the outside of the body.
This narrowing is usually caused by the formation of scar tissue in the urethral lining, which reduces the diameter of the urinary channel and obstructs urinary flow. In many cases, these scars also involve the surrounding spongy tissue, resulting in what is known as spongiofibrosis.
From an anatomical point of view, the urethra is divided into two main parts:
- Anterior urethra (bulbar urethra and penile urethra)
- Posterior urethra (prostatic urethra and membranous urethra)
Depending on the location and extent of the narrowing, symptoms and treatment options may vary.
Risk Factors for Urethral Stricture
Urethral stricture may develop when inflammation, infection, or trauma affects the urethral canal, leading to the formation of scar tissue that narrows the urethra.
The main factors associated with the development of this condition include:
- Urinary tract infections or sexually transmitted infections
- Chronic inflammation of the urethra (urethritis)
- Trauma to the pelvic or perineal region
- Previous urological procedures, such as catheterisation or surgery
- Injuries related to accidents or trauma
In some cases, urethral stricture develops gradually and may not cause symptoms for some time.
Causes of Urethral Stricture
Urethral stricture is usually caused by scarring processes that occur after injury or inflammation of the urethral canal.
The most common causes include:
- Urinary tract infections or urethritis
- Sexually transmitted diseases
- Trauma to the urethra or pelvic region
- Medical procedures or urological surgeries
- Prolonged use of urinary catheters
In some patients, the cause of the stricture cannot be clearly identified and is therefore considered idiopathic urethral stricture.
Types of Urethral Stricture
Urethral strictures can be classified according to the location of the narrowing along the urethra.
In general, there are two main types:
Anterior Urethral Stricture
This affects the bulbar or penile urethra and is the most common form. It may be associated with trauma, infections, or previous medical procedures.
Posterior Urethral Stricture
This involves the prostatic or membranous urethra and may occur, for example, after pelvic trauma or prostate surgery.
Identifying the location of the stricture is essential in order to determine the most appropriate treatment.
Symptoms Associated with Urethral Stricture
Symptoms depend on the degree of narrowing of the urethra and may develop progressively.
The most common signs include:
- Reduced strength of the urinary stream
- Difficulty starting urination
- Thin or spraying urinary stream
- Feeling of incomplete bladder emptying
- Burning sensation or discomfort while urinating
- Recurrent urinary tract infections
When the obstruction is more severe, significant difficulty urinating may occur, a situation that should be evaluated by a doctor.
Diagnosis of Urethral Stricture
When urethral stricture is suspected, diagnosis involves a clinical evaluation and complementary tests that help confirm and characterise the narrowing.
The examinations used may include:
- Uroflowmetry, to assess the strength and pattern of the urinary stream
- Urinary tract ultrasound, to evaluate the bladder and kidneys
- Urethrography, an imaging examination that allows visualisation of the urethral narrowing
- Urethrocystoscopy, an endoscopic examination that enables direct observation of the inside of the urethra
These tests help determine the location, extent, and severity of the stricture.
Have You Noticed Difficulty Urinating or a Reduced Urinary Stream?
Treatment of Urethral Stricture
In general, treatment options may include urethral dilation, internal urethrotomy, or urethroplasty. Regardless of the technique used, the aim of treatment is to restore the normal calibre of the urethra and improve urinary flow.
The main treatment options include:
Urethral Dilation
This technique aims to widen the narrowed area through the controlled disruption of scar tissue fibres, without causing additional inflammation.
Internal Urethrotomy
This is an endoscopic procedure performed under direct visualisation of the stricture using a camera, through a transurethral approach. Although its long-term success rate is more limited, it is often used as a first-line treatment because it is less invasive.
Urethroplasty
Reconstructive urethral surgery is considered the most definitive treatment. It uses tissue transfer techniques, such as grafts or flaps, to enlarge the urethral calibre.
Prognosis of Urethral Stricture
The progression of urethral stricture depends on the location, extent, and cause of the narrowing, as well as the treatment performed.
In many cases, it is possible to significantly improve urinary flow and symptoms after appropriate treatment. Medical follow-up is important to monitor progress and help prevent possible recurrence.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Graduated from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Author of the books "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" and "Protocolos de Urgência em Urologia"
Frequently Asked Questions
Can urethral stricture return after treatment?
Can urethral stricture cause urinary tract infections?
Is urethral stricture a serious condition?
When should I see a urologist?