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Urethral Stricture

Abnormal narrowing of part of the urethra, the passage from the bladder to the outside of the body

  • Can affect adults of any age but most common over the age of 50
  • Almost exclusively affects males
  • Unprotected sex with multiple partners is a risk factor
  • Genetics is not a significant factor

In urethral stricture, scar tissue forms within the wall of the urethra, causing narrowing of the urethra and difficulty passing urine. In developed countries, scar tissue usually results from damage to the area during certain medical procedures, such as bladder catheterization, cystoscopy, or prostatectomy. Scarring from these procedures usually affects people over 50 years old. Worldwide, the most common causes of scarring are persistent urethral inflammation as a result of sexually transmitted infections, such as gonorrhoea or nongonococcal urethritis, and accidental injury to the genital area, such as a fracture of the pelvis. Such conditions are usually more common in young adults.

What are the symptoms?

The symptoms of a stricture gradually get worse over time and may include:

  • Difficulty passing urine.

  • Poor flow of urine.

  • Dribbling after passing urine.

  • The sensation that the bladder has been only partly emptied.

  • Frequent need to pass urine.

An untreated stricture may block the flow of urine from the bladder, causing urinary retention. Incomplete emptying of the bladder can result in cystitis. In a few cases, incomplete emptying may cause an abnormal build-up of pressure in the urinary tract that can damage the kidneys (see Hydronephrosis).

What might be done?

Your doctor will carry out a physical examination to find out if your bladder is enlarged. He or she may then arrange for specialized X-rays of the urinary tract to establish whether your bladder empties completely when you pass urine and to look for bladder abnormalities. A stricture may be suspected if X-rays reveal slow bladder emptying and an abnormally large volume of retained urine. Further studies (see Urodynamic studies) may show whether or not a stricture exists, and cystoscopy and imaging may be used to locate it.

If a stricture is detected, treatment depends on its location and factors such as the age of the affected person. The simplest treatment is urethral dilation (widening). Under local anaesthesia, a slim, flexible instrument is passed into the urethra to stretch the narrowed area gently. The procedure is repeated weekly over several months.

For more serious strictures, the scar tissue may be removed surgically during cystoscopy. If there is substantial scarring, the narrowed section may be removed and the urethra reconstructed using plastic surgery techniques.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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