Occurrence of Urethral Stricture after Surgery, Infection, or Trauma: Symptoms, Diagnosis, and Treatment

The Condition

Urethral stricture is a narrowing or blockage of the urethra, through which urine exits the bladder. This narrowing is often due to build up of collagen fibers and cells called fibroblasts. It is much more common in men than women. This condition can be congenital or acquired, through effects of infection (e.g. gonorrhea), physical trauma (e.g. pelvic fractures), a mass (e.g. carcinoma of the urethra), and medical instruments (e.g. indwelling catheter). A patient may experience urethral stricture after surgery, and this is most likely due to the placement of a catheter during the procedure and/or recovery.

Signs and Symptoms

Symptoms may include decreased urine stream, spraying or double-stream, post-urination dribbling, increased frequency, mild dysuria (pain with urination), and chronic discharge. The presentation can be quite similar to BPH (benign prostate hypertrophy, or enlarged prostate). On physical exam, a physician may notice a palpable mass, depending on the location of the narrowing.

Complications

This fibrosis can extend into nearby structures, including the corpus spongiosum of the penis. The condition can also cause problems upstream in the urinary tract, leading to prostatitis (inflammation of the prostate), hypertrophy of the bladder muscle (which overcompensates for the blockage with excess contraction), and incomplete bladder emptying. In severe, untreated cases, possible serious consequences include urine reflux, hydronephrosis (distention and dilation of the kidney), and even renal failure. Ineffective clearance of urine leads to increased likelihood of infection, and in severe cases, can cause fistulas and abscesses in the urinary tract.

Diagnosis

If signs and symptoms point to this diagnosis, urinary flow rates can be measured with urine collection. Another possible test is urine culture (to determine whether an infection is involved). Imaging studies may confirm the condition and its severity; useful tests include urethrogram, voiding cystourethrogram, and sonogram. A more invasive option for visualizing the urethra is urethroscopy. Other conditions that must be ruled out are BPH and prostate cancer.

Prognosis and Treatment

If symptoms are severe, initial treatment may include dilation, which should provide temporary relief, but which will likely not be curative because of the build-up of scar tissue. Another treatment option is endoscopic lysis with a knife; this is safe and effective in the longterm, but does not prevent recurrence. Finally, surgical correction is a more risky but potentially necessary option. This condition must be monitored for at least a year after treatment to ensure that it does not recur.

References

Cooper Christopher S, Joudi Fadi N, Williams Richard D, "Chapter 38. Urology" (Chapter). Doherty GM: CURRENT Diagnosis & Treatment: Surgery, 13e: https://www.accessmedicine.com.ezproxy.galter.northwestern.edu/content.aspx?aID=5312459.

McAninch Jack W, "Chapter 40. Disorders of the Penis & Male Urethra" (Chapter). Tanagho EA, McAninch JW: Smith’s General Urology, 17e: https://www.accessmedicine.com.ezproxy.galter.northwestern.edu/content.aspx?aID=3131172.