A urethral stricture is scarring that leads to a narrowing of the tube that allows us to pass urine outside of the body, which can lead to medical problems in men and women.
Overview of Urethral Stricture
The urethra is the thin tube which allows us to pass urine from the bladder out of the body. A urethral stricture is scarring from swelling, injury or infection that leads to a narrowing of the urethra which then blocks or restricts this flow of urine. This restricted flow can cause medical problems in the urinary tract, including inflammation or infection.
Urethral stricture is more common in males than it is in females.
Symptoms of Urethral Stricture
- Reduced urinary flow
- Straining/Incomplete emptying
- Spraying/splitting of the stream
- Retention of urine
- Rarely obstructive renal failure
Diagnosing Urethral Stricture
- History and examination
- Flow rate and PVR
- Flexible cystoscopy
- Ascending and descending urethrogram
Treatments for Urethral Stricture
Management depends on:
- location of the stricture
- Length of the stricture
- Aetiology (trauma/radiotherapy worse than other causes)
- Patients co-morbities
- Patients choice (risks vs benefits of treatments vs symptom severity)
- Surgical skill set
- Largely secondary to LS/BXO or post circumcision
- Meatal dilatation
- Meatotomy (ventral +/- dorsal)
- Malone meatoplasty (ventral and dorsal meatatomy with an inverted V shaped relieving incision)
- If the stenosis is >5mm long the above will fail and require self dilatation or further surgery
Distal penile urethra
- Previous hypospadias surgery
- Urethral dilatation +/- ISD (this can be repeated)
- 1 or 2 stage distal buccal mucosa graft (BMG) urethroplasty
Penile urethra (not that common in isolation)
- Urethral dilatation +/- ISD
- Anastomotic (short/traumatic) up to 1.5cm
- Dorsal BMG Urethroplasty (longer strictures >1.5cm)
- Bulbar BMG Urethroplasty (ventral/dorsal/trans-ventral dorsal)
- Traumatic/up to 1cm
- Anastomotic Urethroplasty (spatulated end to end)
Ventral vs dorsal
- Location of the stricture in relation to the CS quality/abundance
- Rough guide:
- If CS >1.5cm in diameter – ventral patch
- If CS<1.5cm in diameter – dorsal patch
- Mid/proximal bulbar urethra – ventral
- Distal bulbar/penile – dorsal
- BS muscle is cut off for ventral approach
- Stricture recurrence 10-15% with both techniques
- Urethral dilatation + ISD
- Kulkarni urethroplasty (BMG augmentation)
- Bladder mucosa tube substitution
- Perineal urethrostomy (if you have any healthy proximal bulbar urethra)
- Supra-pubic catheter
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Contact your GP and ask for a referral to the Urology Partnership.
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