Urethral strictures

What is a urethral stricture?

A urethral stricture is a narrowing of your urethra, the tube that carries urine out of your body. Scar tissue causes the narrowing, making it harder for urine to flow and often producing a slow or weak stream when you pee.

What are the symptoms of a urethral stricture?

The main sign of a urethral stricture is a slow or weak flow of urine. Other symptoms can include:

• straining to pee
• pain while peeing
• needing to pee more often, or feeling you haven't fully emptied your bladder
• blood in your urine or semen
• repeated urinary tract infections, or inflammation in your prostate gland (prostatitis).

If a stricture is severe, you may suddenly be unable to pee at all. This is a medical emergency, since urine can back up and damage your kidneys.

What causes a urethral stricture, and who is at risk?

A urethral stricture usually develops when scar tissue narrows the urethra, following inflammation or an injury. Causes include:

• an infection, including sexually transmitted infections
• an injury to your penis, scrotum or pelvis
• medical procedures that pass instruments or catheters through your urethra, such as a catheter, cystoscopy, or surgery for an enlarged prostate or prostate cancer
• radiotherapy to the pelvic area
• rarely, being born with the condition, or a tumour pressing on the urethra.

In many cases, no clear cause is found. Urethral strictures are much more common in men, since the male urethra is longer, and become more common with age, particularly from your mid-50s onwards. You can help protect yourself by practising safe sex and avoiding unnecessary use of urinary catheters.

Are there different types of urethral stricture?

Yes. Doctors classify strictures by where they occur along the urethra:

• Anterior strictures, in the part of the urethra running along the underside of the penis; these are the most common type, and most often affect a section called the bulbar urethra.
• Posterior strictures, closer to the bladder; these are less common and often related to a pelvic injury.

Strictures are rare in women, since the female urethra is much shorter, but they can still occur, often linked to previous surgery, childbirth injury, or catheterisation.

How is a urethral stricture diagnosed?

Your doctor will ask about your symptoms and may arrange tests to see how well you're emptying your bladder, including a urine flow test and a scan to check how much urine remains in your bladder afterwards.

To confirm a stricture and find out its size and location, you may need:

• a cystoscopy, where a thin, flexible camera is passed into your urethra, usually under local anaesthetic (or general anaesthetic in children)
• a retrograde urethrogram, an X-ray taken after a contrast dye is passed into your urethra.

How is a urethral stricture treated?

Treatment depends on the location, length and severity of the stricture. Some minor strictures with no troublesome symptoms may just be monitored.

Non-surgical treatment

• urethral dilation, where instruments are used to gradually stretch the narrowed area; this is often tried first, though the narrowing can return over time
• intermittent self-catheterisation, where you pass a thin catheter yourself at intervals to keep the urethra open, sometimes used alongside other treatments or if surgery isn't suitable.

Long-term catheters, if you need one, are usually changed every 8 to 12 weeks.

Surgical treatment

Surgical options include:

• internal urethrotomy, where a surgeon uses a small blade or laser, passed through a scope, to cut away the scar tissue
• anastomotic urethroplasty, where a short stricture is cut out and the healthy ends of the urethra joined back together; this is most suitable for short strictures and has a high success rate
• graft urethroplasty, where a longer stricture is widened using a graft, often taken from the lining of your cheek (buccal mucosa)

These procedures usually need a one or two-day hospital stay, a catheter in place for two to three weeks afterwards, and four to six weeks off work. Urethroplasty has a long-term success rate of more than 85%, and is generally more effective than repeated dilation for longer or recurring strictures.

When should I see a doctor?

See a doctor if you have a slow or weak urine stream, or other symptoms of a urethral stricture.

Get medical help straight away if you suddenly cannot pee at all, have severe pain while peeing, notice blood in your urine, or develop signs of infection such as a fever. In children, seek treatment straight away if they're struggling to empty their bladder regularly, as this increases the risk of infection and, occasionally, kidney damage.