Urethral Stricture

Introduction

Urethral Stricture is an abnormal narrowing or loss of distensibility of any part of the urethra, as a result of fibrosis.
It is one of the commonest causes of urine retention in tropical Africa.
It is very rare in females.
It may result from trauma or inflammation; it may equally be iatrogenic.

Causes of urethral stricture

1. Traumatic causes:

  • Penetrating or blunt injury to the urethra
  • From pelvic fractures or falling astride an object

2. Infective causes:

  • Gonococcal urethritis or non-gonococcal urethritis from chlamydia, tuberculosis or schistosomiasis

3. latrogenic causes:

  • Urethral instrumentations e.g. catheterization and urethroscopy
  • It may be congenital
  • May be complete or partial, single or multiple
  • Can affect any part of the urethra, anterior or posterior

Symptoms and clinical features of urethral stricture

  1. Dysuria
  2. Frequency
  3. Urgency
  4. Poor stream
  5. Straining
  6. Hesitancy
  7. Dribbling

Examination of the external genitalia may reveal:

  1. Urethral indurations.
  2. Periurethral or perineal abscess
  3. Urinary fistula

Differential diagnoses

  • Benign prostatic hypertrophy
  • Prostate cancer
  • Bladder calculi
  • Bladder neck stenosis

Complications of urethral stricture

  1. Urethral/bladder calculi
  2. Urinary tract infections
  3. Urinary retention
  4. Perineal urinary fistulae
  5. Progressive renal failure
  6. Fournier’s gangrene

Investigations

  • Urinalysis
  • Urethroscopy
  • Urine microscopy, culture and sensitivity
  • Urethrogram
  • Serum Urea, Electrolytes and Creatinine
  • Uroflowmetry
  • Abdominal ultrasound
  • Full Blood Count

Treatment for urethral stricture

Treatment objective

  • To restore urethral patency

Drug treatment

  • None

Non-drug treatment

  • Serial dilatation/bouginage
  • Endoscopic direct visual urethrotomy
  • Urethroplasty: excision and end-to-end anastomosis
  • Substitution urethroplasty

Prevention

  • Ensure prevention of sexually transmitted infections.
  • Prompt and appropriate treatment of sexually transmitted infections
  • Care and attention to asepsis during instrumentation procedures involving the urethra