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Urethral Strictures
The urethra is the tube that allows urine to pass from the bladder out of the body. In women, this
tube is quite short and therefore is less problematic than the male urethra. Men and women can get
infections of the urethra, but usually only men have trouble with narrowing of their urethra.
A man can be born with urethral abnormalities such as hypospadias (the urethral meatus is not at the
tip of the penis), or meatal stenosis where the hole at the tip of the penis is too small.
Most of these abnormalities are corrected or treated in children. Occasionally, we treat these problems
in adults also.
The most common abnormality seen in the adult male urethra is a stricture, or a scar, that narrows the caliber of the urethra. This narrowing makes urination difficult and often leads to bladder decompensation, infections, and stones. The most common place to find a stricture is in the bulbar urethra, the part that men sit on, closest to the prostate and bladder. Usually, no cause for the stricture is found, but the most common causes are sexually transmitted diseases such as gonorrhea, straddle injuries, or previous catherization or instrumentation. A rarer but problematic inflammatory condition known as balanitis xerotica obliterans can also cause urethral strictures.
The symptoms of a urethral stricture are a slow urinary stream and dribbling after urination. The most common method to diagnose a stricture is to perform cystoscopy and look into the urethra for a narrowing. To aid in planning treatment, sometimes a special x-ray called a retrograde urethrogram is performed.
The main difficulty in treating urethral strictures is that they have the tendency to recur, and the likelihood of recurrence relates very much to the type of treatment used to eradicate the problem. Urethral dilation is the easiest and simplest way to treat the stricture. Here, the stricture is stretched to a larger size, and this can often be done in the office. The problem is that the stricture will recur to some degree nearly 80% of the time and thus dilation commonly will lead to repeat dilations.
Because of the fact that dilation has such a high recurrence rate, and that every dilation tends to lead to a longer stricture, we at USW advocate incising the stricture under anesthesia. This is a simple, outpatient procedure whereby the scar is cut with the hope that healthy tissue will fill in the incision. The patient must wear a catheter for a day or two at home, but the risk of recurrence is less than dilation at 30-50%.
The most definitive way to treat urethral strictures is with surgery. Here, the diseased urethra is reconstructed with healthy tissue such as penile skin or the lining of the cheek. This is much more involved than dilation or incision, and requires a short hospital stay and catheterization for at least a week. However, urethral reconstruction is far more definitive than the other options listed above. Recurrence rate is typically less than 10%. Surgery such as this is offered by both Dr. Engel and Dr. Frazier, and is usually reserved for patients who have already undergone an incision and have recurred. This represents in many ways plastic reconstructive surgery, and such surgery is an area of specialization within the field of urology that is practiced by a minority of urologists. USW is lucky to have two surgeons with expertise in this area.
If you believe that you may have a urethral stricture, or if you have undergone dilation or incision elsewhere and desire a formal reconstruction, please come in for a consultation so that we may determine the proper course of action.