Urethral Stricture |

Urethral stenosis is a stricture which occurs when a part of the urethra become narrowed. Any section of the urethra may be affected. There is usually some scar tissue around the affected part of the urethra that causes the narrowing. The length of strictures vary from less than 1cm to 4cm or longer.

Causes of urethral stenosis

• Injury or damage to the urethra: Includes surgical interventions. Healing can result in scar tissue causing a stricture.
• Infection of the urethra: Sexually transmitted infections or infection as a complication of long-term use of a catheter to drain the bladder. Infection may cause inflammation in the tissues in and around the urethra. These infections usually clear with treatment but may leave some scar tissue at the site of the inflammation which can cause a stricture.
• Rare causes: Congenital or cancer spreading from bladder or prostate

Symptoms

• Reduced urine flow.
• Spraying of urine.
• Dribbling of urine for a while after urination.
• Mild pain on micturition.

Surgical Intervention for Urethral Stenosis

Dilatation (widening) of the stricture: A rod is passed into the urethra. Rods of increasing thickness are gently inserted to gradually widen the narrowed stricture. The aim is to stretch the stricture without causing additional scarring. However, a stricture often tends to gradually narrow again after each dilation. Therefore, a repeat dilation is commonly needed every so often when symptoms recur. (Some people are given a self-lubricating catheter which they insert themselves regularly to keep a stricture dilated.)

Urethrotomy: An endoscope is passed into the urethra to view the stricture. A knife, passed down the scope, cuts the stricture widening the channel. However, like dilation, the stricture may reform and the procedure may have to be repeated. A longer stricture has an increased risk of requiring repeat urethrotomies

Urethroplasty: The stricture (narrowed segment) is excised and the urethra joined together over a catheter.
If an additional skin graft is required this is usually a buccal mucosal graft taken from inside the cheek. The strictured tract is incised and surrounding urethral tissue mobilised. The graft is sutured and quilted on the bed of the dorsal urethral incision using interrupted sutures. The urethra is closed over a catheter which will be left place for approx. 2 weeks.

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