Urethral strictures

 

Urethral strictures are a medical condition where the urethra — the tube that carries urine out of the body from the bladder — becomes narrowed. This narrowing can be caused by various factors, including injury, infection, inflammation, or previous medical procedures. The main symptom of a urethral stricture is a weakened urinary stream, but it can also lead to urinary retention, pain during urination, increased frequency of urination, and urinary tract infections.

Urethral strictures can arise from a variety of causes, and understanding these is important for both prevention and treatment. The common causes include:

  1. Trauma or Injury: Physical damage to the urethra or pelvic area, such as from a fall, a straddle injury, or a pelvic fracture, can lead to scar tissue formation and subsequent strictures. This is more common in men due to the longer length of the male urethra.

  2. Medical Procedures: Procedures involving the urethra, like catheter insertion, surgery, or endoscopic procedures, can cause injury or scarring leading to strictures.

  3. Infections: Urethral infections, particularly sexually transmitted infections like gonorrhea or chlamydia, can cause inflammation and scarring. Repeated urinary tract infections may also contribute to stricture formation.

  4. Inflammatory Conditions: Certain conditions, such as lichen sclerosus or balanitis xerotica obliterans, can cause inflammation of the urethra and surrounding tissues, leading to strictures.

  5. Radiation Therapy: Radiation used to treat cancers in the pelvic area can cause damage to the urethral tissue, resulting in strictures.

  6. Congenital Factors: Some individuals may be born with a narrow urethra or develop strictures during early childhood.

  7. Iatrogenic Causes: This refers to complications resulting from other medical treatments or interventions.

  8. Unknown Causes: In some cases, the exact cause of a urethral stricture remains unknown. This is termed idiopathic urethral stricture.

Prevention of urethral strictures often involves minimizing risk factors where possible, such as using caution with procedures involving the urethra, practicing safe sex to prevent STIs, and managing any underlying inflammatory conditions effectively. However, some causes, like trauma or congenital factors, may not be easily preventable. Regular medical check-ups and early treatment of urinary symptoms can help in early diagnosis and management of urethral strictures.

The diagnosis of urethral strictures typically involves a combination of patient history, physical examination, and diagnostic tests. These tests may include a urethrogram, which involves taking X-ray images of the urethra after injecting a contrast dye, or cystoscopy, where a thin scope is inserted into the urethra to visually inspect it.

 

Management of urethral strictures

The management of urethral strictures involves a combination of medical and surgical approaches, tailored to the individual’s specific condition. Here’s a detailed look at the various management strategies:

  1. Observation and Monitoring: In cases of minor strictures without significant symptoms, a watchful waiting approach may be adopted. Regular monitoring and follow-up appointments are essential in this scenario.

  2. Dilation and Stenting: Urethral dilation involves gradually stretching the stricture with specialized instruments. It’s a relatively non-invasive method but often provides only temporary relief. Stenting involves placing a small tube in the urethra to keep it open, which can be more long-lasting but may also have complications. A newer technique involves balloon dilatation (Optilume)with a balloon coated with a special drug called paclitaxel which can reduce the frequency of urethral stricture occurrence compared to urethrotomy / standard dilatation.

Optilume procedure being performed by Prof Asif Raza

  1. Urethrotomy: This involves making a cut in the stricture to open it up, usually using a special instrument inserted through the urethra. It’s less invasive than open surgery but may not be a permanent solution, as strictures can recur.

  2. Urethroplasty: This surgical procedure involves reconstructing or replacing the narrowed section of the urethra. It can be done using tissue grafts from the patient or flaps of skin. Urethroplasty is often considered the most definitive treatment for urethral strictures, especially for longer or recurrent strictures.

  3. Self-Catheterization: In some cases, particularly when surgery is not an option, patients may be taught to periodically insert a catheter into the urethra to prevent narrowing. This can be effective but requires patient compliance and proper hygiene to avoid infections.

  4. Managing Underlying Conditions: If the stricture is caused by an underlying condition, such as an infection or inflammatory disease, treating that condition is a crucial part of management.

  5. Lifestyle Modifications: Simple measures like increased fluid intake, avoiding irritants (like caffeine and alcohol), and practicing good genital hygiene can help in managing symptoms.

  6. Pain Management: If the stricture causes pain or discomfort, pain management strategies, including medications, may be necessary.

  7. Follow-Up Care: Regular follow-up is crucial to monitor the status of the stricture and assess the effectiveness of the treatment. This may include repeat urethrography, cystoscopy, or urine flow studies.

  8. Specialized Interventions: In some cases, more specialized interventions may be needed, such as laser therapy or the use of advanced surgical techniques.

The choice of treatment depends on several factors, including the length, location, and cause of the stricture, as well as the patient’s overall health and preferences. It’s important for patients to work closely with their healthcare provider, usually a urologist, to determine the best treatment plan. Early and appropriate management can significantly improve the quality of life for individuals with urethral strictures.

 
 
 

Treatment for urethral strictures depends on the severity and cause of the stricture. Options include:

  1. Dilation: Stretching the stricture with gradually increasing sizes of dilators or with a balloon. Please click on the link for more information. (Optilume)
  2. Urethrotomy: An internal procedure to cut the stricture.
  3. Urethroplasty: Surgical reconstruction of the urethra, which is often considered for longer or more complex strictures.

In some cases, self-catheterization (ISC) may be recommended to prevent the stricture from recurring.