Condition: Urethral Stricture
Brief Overview: A urethral stricture is a narrowing of the urethra caused by scarring or fibrosis, leading to obstructed urinary flow. It can occur anywhere along the urethra but is most common in the anterior segment in men.
This condition often develops gradually and may present with weak urinary stream, straining, urinary retention, or recurrent urinary tract infections. While medications can help manage associated symptoms, definitive treatment typically involves dilation, urethrotomy, or urethroplasty.
Prevalence: Urethral stricture affects an estimated ~1% of males. It is rare in females.
Etiology:
- Can be idiopathic (unknown etiology)
- Urethral trauma
- Infection – example: STIs
- Surgical trauma/damage
- Lichen sclerosis
- Repeated catheterization
Risk Factors:
- Male
- Increasing age
- History of urethral trauma or instrumentation
- Past or untreated STIs
- Lichen sclerosis
Commonly Associated Conditions:
- Recurrent UTIs
- Chronic urinary retention
- Bladder stones
- Sexual dysfunction
Common Medications:
- There are no medications to strictly treat urethral strictures. Treatment options are procedural. Medications may be used to support an upcoming procedure, to manage symptoms or underlying/concurrent conditions, or to prevent infection.
Common Labs, Imaging, and Tests:
- Cystourethroscopy
- Retrograde urethrogram (RUG)
- Voiding cystourethrogram (VCUG)
- Ultrasound urethrography
Common Symptoms:
- Decreased urinary stream
- Dysuria
- UTIs
- Incomplete bladder emptying
- Urinary spraying
- Decreased force of ejaculate during orgasm
Common Treatments:
- No treatment may be needed if asymptomatic
- Urethral dilation
- Internal urethrotomy
- Urethral reconstruction
- Urinary diversion procedures
Physical Findings:
- May have distended bladder or suprapubic fullness if retention present
- Weak or abnormal urinary stream noted on observation
- Signs of infection (fever, tenderness) if UTI present
Potential Complications and Contraindications:
- Recurrent or worsening urinary retention
- Recurrent UTIs
- Hydronephrosis or kidney damage
- Bladder stones
- Erectile or ejaculatory dysfunction
- Complications from repeated procedures (false passage, scarring)
General Health and Lifestyle Guidance:
- Encourage prompt reporting of urinary changes (weak stream, incomplete emptying) to healthcare provider
- Educate on hydration and bladder health. Advise the patient to discuss hydration recommendations with healthcare provider
- Catheter care instructions if intermittent catheterization is used.
- Work with your healthcare provider to prevent constipation and avoid straining, which can worsen symptoms.
- Promote follow-up with urology to monitor for recurrence or progression.
- Discuss infection prevention strategies (e.g., hygiene, hydration, timely treatment of UTIs).
Suggested Questions to Ask Patients:
- How long have you experienced urinary symptoms (weak stream, incomplete emptying)?
- Have you had recurrent UTIs or needed catheterization?
- Have you undergone any prior urologic procedures or trauma to the area?
- Are you currently taking any medications for urinary symptoms?
- Have your symptoms worsened over time?
- How is this condition impacting your daily life?
Suggested Talking Points:
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
- Medications may help with symptoms, but procedures are often needed for long-term relief.
- Follow-up with urology is key to preventing recurrence or kidney complications.
- Early treatment can reduce the risk of infections and bladder damage.
- If you notice worsening symptoms, it’s important to call your provider promptly.
Sources:
- https://www.uptodate.com/contents/strictures-of-the-adult-male-urethra?search=urethral%20stricture&source=search_result&selectedTitle=1~74&usage_type=default&display_rank=1#H698386
- https://my.clevelandclinic.org/health/diseases/urethral-stricture
- https://www.urologyhealth.org/urology-a-z/u/urethral-stricture-disease#Treatment