Have you been diagnosed or do you suspect you have an Urethral Stricture? If you are going through this diagnosis it can be a troubling time for you and those close to you. Having an understanding of the physicality of this issue can help you feel back in control, giving you the confidence to face the next steps in your treatment to get you back to your normal daily life.
What is a Urethral Stricture?
Let’s start with the basics. The urethra is a tube that carries urine from the bladder to the tip of the penis in males, or the perineum in females. A Urethral Structure is when this tube becomes borrowed or blocked due to scarring.
What Causes a Urethral Stricture?
Urethral Strictures are caused by scarring, most commonly due to one of the following:
- Previous trauma e.g. catheterisation, pelvic fractures, blunt force trauma
- Infection of the urethra
- Inflammatory processes e.g. lichen sclerosus
- A long-term complication of previous surgery for hypospadias (the correction of congenital anomalies of the urethra where the opening of the urethra is located on the underside of the penis instead of the tip)
- Urethral Fistula (this is an abnormal connection between the urethra and another surface, most commonly skin, leading to leakage of urine and infections)
Strictures are most commonly found in the bulbar urethra (see diagram – it is the area behind the scrotum called the perineum). It is also common to find strictures in the penile urethra. Whilst it is rare for strictures to occur further back in the sphincteric (membranous) urethra or prostate, but it can happen and tends to be as a result of trauma or surgery.
What Are the Symptoms of a Urethral Stricture?
There are a few different symptoms of a Urethral Stricture to look out for. It’s important to be seen by a medical professional if you are experiencing one or more of the following symptoms:
- Poor urinary flow rate
- Difficulty in complete emptying of the bladder
- Repeated Urinary Tract Infections (UTI’s)
- Problems with frequency or urgency of urination, suggesting a urinary storage issue
- Acute retention of urine i.e. the inability to urinate signifying an obstruction or complete blockage. This is a medical emergency, and you should be seen immediately by a medical professional
How is a Urethral Stricture Diagnosed?
Depending on the degree of symptoms being experienced, there are a couple of procedures that can be performed to diagnose a Urethral Stricture and thus determine the best line of treatment for each individual case.
Cystoscopy
Some of the earlier symptoms outlined above (decreased flow rate, recurrent UTI’s, frequency and urgency of urination) can be investigated via telescopic inspection of the urethra and bladder. This procedure is called a Cystoscopy and can be carried out quickly and easily with a local anaesthetic. Depending on where the stricture is, sometimes it’s not possible to see beyond it.
Urethrogram
Further investigation can be carried out via a type of X-ray called a Urethrogram. During this procedure, some x-ray contrast dye is inserted into the tip of the urethra. This procedure can give more accurate information about the structure such as the length, location and calibre.
What are the Treatment Options for Urethral Strictures?
Depending on the location and severity of the stricture, there are various treatment options available.
Urethral Dilatation
Urethral Dilatation is when a patient uses a catheter device once or twice a week to help keep the urethra pipe open and prevent the stricture from causing an obstruction or blockage. This works by stretching the scar tissue.
Depending on the size and severity of the stricture, this option can be used both as a preventative measure if caught early enough, or post surgery after an urethrotomy to help keep the urethra open.
Urethroplasty Procedures
In some cases where the stricture is more severe (likely to cause an imminent blockage or not responding to the above treatments) or is in a location which makes the above treatments impossible, then a type of Urethroplasty may be necessary. For these procedures you would undergo a general anaesthetic.
Urethrotomy
An Urethrotomy is done using an endoscopic camera called a cystoscope, which is inserted into the urethra and guides the surgical instrument used to cut away the scar tissue inside the urethra tube.
Anastomotic Urethroplasty
In scenarios where the stricture is very dense, short and located in the bulbar urethra (see diagram), a procedure called an Anastomotic Urethroplasty can be performed. This is when the scarred segment of urethra is removed, and the remaining ends are joined up using fine sutures. The outcomes following this type of surgery are typically excellent, with approximately 90% of men not requiring any further surgery over the following 10 years.
1 Stage Urethroplasty (or Buccal Graft Urethroplasty)
When there is some remaining healthy inner lining (mucosa) or a stricture is longer, a grafting procedure may be recommended. This procedure is an open repair of the urethra and is carried out via a cut in the skin overlying the stricture. The scarred part of urethra is widened using grafting techniques. The most common type of graft is using a part of the inside lining of the cheek (called a buccal mucosa graft or BMG).
Depending on the complexity of the stricture, a 1 stage Urethroplasty procedure can take between 1 and 3 hours to perform. Typically, you can expect to stay overnight in hospital and will be sent home with an indwelling catheter in the bladder for 2 weeks. We would advise not to commit to going back to work during this period, but working from home sitting at a desk should be possible.
The outcomes of this type of Urethral Stricture repair are also very good, with an 85%+ success rate.
2 Stage Urethroplasty (or Penile Urethroplasty)
Whilst most strictures in the bulbar urethra can be repaired in one operation (as above), sometimes strictures can occur further down the penile urethra towards the tip. In this scenario, there are the options of a single stage or 2-stage Urethroplasty operation.
The first stage of the procedure involves opening the urethra and laying down a graft on the underneath side of the penis. If a 2-stage approach is being used then the incision is left open to allow the graft to settle for approximately 3 months. During this time, it is likely to be necessary to urinate whilst sitting down.
The second stage of the procedure is carried out after 3 months and involves the closing of the urethra and penis in layers, thus restoring the opening (meatus) to the penis tip.
You will be sent home from hospital with a catheter for 2 weeks, at which point you will come back for a follow up. Your urine flow rate will be checked, as well as bladder emptying function. There will be regular follow ups for the first year, after which time patients are usually discharged.
Get in Touch with our Expert Team of Urologists
Here at the London Men’s Clinic, we have a team of highly trained and nationally-recognised urologists who offer state-of-the-art urological care in a warm, caring and patient focused setting.
We know this can be a worrying time and we are here to help. If you are experiencing any of the symptoms outlined above and would like to make an appointment, or have been diagnosed with an Urethral Stricture and are looking for treatment options then please get in touch with us today.
