Urethral stricture is an uncommon condition that results in blockage of the urethra or “peeing tube.” Stricture formation results in a narrow circular ring of scar tissue, which restricts the flow of urine.
Signs and symptoms
Most men will experience symptoms, such as slow stream, frequent urination, feelings of incomplete emptying, recurrent infections and straining to void. In severe cases, urinary retention may prevent individuals from urinating and may require emergency intervention. In severely injured patients, blood in the urine may also be seen.
The cause of the majority of urethral strictures is unknown. The most common cause is trauma from being struck in the area between the legs, known as the perineum. Other causes include: inflammatory diseases, i.e., lichen sclerosis and balanitis xerotica obliterans; infections, i.e., sexually transmitted disease; congenital abnormalities; instrumentation, i.e., surgery, catheter placement or pelvic fracture.
Patient evaluation starts with a thorough history and physical. The majority of patients will require a retrograde urethrogram, or RUG. This is an outpatient x-ray test that shows the location, density, and length of the urethral stricture and is required for planning a repair. Other additional tests can include insertion of a camera into the bladder, called cystoscopy.
The treatment for urethral stricture is customized to fit each individual patient. Most urethroplasties require an overnight stay in the hospital.
This can involve internally leading or dilating the scar with the aid of a camera. This requires no external incisions and can be performed on an outpatient basis. Unfortunately, for the majority of patients, this treatment is ineffective and may only produce temporary results. The majority will go on to require some form of open repair, which is accomplished in a variety of ways.
This technique involves harvesting a portion of skin from the penis in order to place a patch over the narrowed portion of the urethra. The skin remains connected to the muscle and underlying blood vessels.
Buccal mucosa urethroplasty
This specialized technique is only performed by a few surgeons in the United States. The inner lining of the mouth is harvested to create a patch over the scarred area of the urethra. The buccal mucosa is transplanted to the area of repair, where it will grow new blood vessels. The tissue heals very well, is resistant to infection and seems to remain effective for many years after repair. The majority of patients are back to eating normal food after just 48 hours. This does not cause facial scaring or difficulty with speech.
Anastomotic or end-to-end urethroplasty
This is the simplest form of urethroplasty in which the scarred portion of the urethra is removed and the two ends are sewn together.
A specialized technique to repair urethras that have been severely injured due to pelvic fracture, which causes a disruption of the urethra with massive scar formation. The scar must be carefully removed and the urethral ends reconnected.