What Is Urethral Stricture, How Is It Diagnosed, and What Are the Treatment Methods?

What Is Urethral Stricture?

Urethral stricture is a structural disorder of the excretory system that can be seen in both women and men. The urethra is the last part of the urinary tract and, in a healthy body, is generally 8-9 mm in diameter in women or men. Narrowing of the urethra can seriously affect a person's comfort, making urination difficult and painful. Untreated urethral stricture may initially present with minor problems, but gradually become a major issue that adversely affects the patient's life. In cases of severe narrowing, even loss of the kidney may occur.

Urethral diseases occur more frequently in older men. However, infection-related and childbirth-related urethral narrowing can also be seen in women. Technological options such as urethrotomy, dilation, urethroplasty, permanent and temporary stent placement, and laser treatment of urethral stricture, under the leadership of experienced physicians, can help prevent this problem.

What Are the Causes of Urethral Stricture and Why Does It Occur?

The urethra is the organ at the end of the excretory system, and its anatomy and length differ between men and women. To understand the anatomy of the urethra and the significance of its deformations, it is important for patients to have knowledge about the excretory system. The main and largest organs of the excretory system are the kidneys. Within the kidneys, urine is separated from systematically filtered blood. In the collecting ducts, the final part of the kidneys, urine travels toward the bladder. The fluid that first takes on the form of urine in the collecting ducts is sent to the bladder before being expelled from the body. The organ that conducts transmission between the kidney and the bladder is the ureter. The ureter, approximately 25-30 cm long, carries urine to the bladder. After waiting in the bladder for a while, urine moves toward the urethra to be expelled from the body.

The urethra is 15-20 cm long in men. In women, it is shorter, approximately 4 cm. The reason the urethra is shorter in women is that female urogenital organs occupy more space in the abdominal cavity than in men. In men, the testes and penis are located outside the body, whereas in women, the vagina, uterus and ovaries are located in the abdominal cavity. The longer urethra in men explains why diseases and anatomical deformations are seen more often than in women. In other words, urethral stricture is seen more frequently in men than in women.

Urethral stricture can develop due to many different causes. Urethral stricture may occur for the following reasons:

Trauma caused by an invasive procedure such as endoscopy or catheterization,

Urogenital infections such as chlamydia,

Radiation therapy,

Tumorous growth in the urethra or prostate,

Urethral damage occurring after catheter placement,

Deformation after kidney stone surgery,

Trauma to the urethra from vaginal delivery.

In women, urethral stricture progresses more symptomatically than in men, and symptoms are felt in a shorter time. The most common causes in women are trauma during vaginal delivery, trauma during surgery, and infections.

Today, there are treatment methods for urethral stricture that can be corrected with simple surgical procedures and offer successful outcomes. Therefore, if you suspect urethral stricture and think the causes of the disease may be present in you, you can easily make an appointment at a healthcare facility.

How Is Urethral Stricture Diagnosed?

Choosing a specialist physician for urethral stricture surgery and trust between physician and patient are very important. If the source of the disease involves trauma, especially after surgery, starting treatment after examination by a physician the patient trusts can affect success. Before a urethral stricture diagnosis is confirmed, patients may present to clinics with common complaints. The symptoms that lead to confirmation of the diagnosis can generally be listed as follows:

A feeling that the bladder is not completely emptied after urinating,

Burning and pain while urinating,

Spraying urinary stream,

Bloody or dark-colored urine,

Blood in the ejaculate (semen) in men,

History of cystitis,

Urinary leakage throughout the day,

Frequent feeling of pain in the abdomen,

Dribbling urinary stream.

The detailed history of patients who present to the clinic with complaints suggesting urethral stricture is evaluated. After a physical examination and history-taking, some additional tests may be requested to clarify the diagnosis. Tests that may be required for a definitive diagnosis are:

Ultrasound (USG),

CT scan (BT),

Blood test,

Cystoscopy,

Retrograde urethrography,

Uroflowmetry test (urine flow test).

Criteria such as the speed of urine flow, the degree to which the bladder empties after urination, and the adequacy of urethral diameter help with diagnosis. Through these tests and imaging methods, urethral stricture can be detected and a definitive diagnosis can be made.

How Is Urethral Stricture Treated? What Are the Treatment Methods?

Urethral stricture can cause pain and a burning sensation during urination, and may make patients feel that the bladder is not sufficiently emptied after urinating. Urethral stricture can develop for different reasons and may follow a different course in each patient. If a narrowing is present at an early stage and is not treated, it can cause serious problems in later stages. When urethral stricture is not treated, the degree of narrowing in the canal increases and blockages can develop. This may lead to problems such as kidney stone formation due to accumulation of urine and urinary contents, increased workload on the kidney, and development of infection. Delayed treatments can lead to conditions that progress to loss of kidney function. Therefore, it is important that patients diagnosed with urethral stricture be treated while showing only a few symptoms, so that the problem is resolved before it progresses.

Treatment and follow-up procedures are not the same for every patient with urethral stricture. Depending on the size of the stricture, the follow-up interval and the planned treatment model may change. In patients undergoing urodynamic testing, if urine flow is less than 10 milliliters per second, obstruction (blockage) or stricture may be present. Treatment is planned through joint decision of the physician and patient, considering the most appropriate and comfortable method. Today, these treatment methods are applied as follows:

Dilation: A thin catheter is inserted from the urethra toward the bladder to widen the canal. An anesthetic cream is applied before the procedure.

Laser Treatment for Urethral Stricture: For this procedure, which is performed under anesthesia, the stricture must be located in a small area. For treatment, the tissue at the narrowed area is removed with the help of a tube with a laser device at its tip, advanced through the canal. A catheter needs to be used for several days after the procedure.

Urethroplasty: If the stricture is longer than 2 cm, that segment of the urethra can be removed through an open surgical operation called urethroplasty. After the narrowed part of the urethra is removed, the exposed ends of the canal are joined. The first goal for patients is closed surgery. To avoid scars from open surgery, treatments that are performed in a short time and do not require dressings are planned. However, in severe cases of stricture, open surgery may be the only option.

Stent Placement: Especially in men, stents may be the most effective method for treating strictures in the bulbous urethra, the section close to the penis. Stents can be placed permanently or temporarily and are performed under local anesthesia.

Today, thanks to advances in medical technology, urethral stricture surgery can be planned as closed or open surgery. The first goal in operations is comfortable solutions that leave no scars and require a short recovery period.

Frequently Asked Questions About Urethral Stricture

Patients diagnosed with urethral stricture may ask questions to get sufficient information about the process. You can find below the questions patients frequently ask about diagnosis, the treatment process and post-treatment. Yes, urethral stricture can be prevented through early diagnosis. For those with risk factors for the disease, when the possibility of urethral stricture development is noticed during regular check-ups, the physician may change the frequency of follow-up. In this way, prophylactic treatment of the disease (preventive treatment before it develops) can be carried out. Delayed treatment may result in serious problems that can progress to loss of kidney function. Therefore, urethral stricture must be treated through early diagnosis, before it progresses and before other organs of the excretory system are affected. Urethral stricture, a condition that requires treatment, usually does not resolve on its own. However, in very rare cases, minor strictures caused by trauma may improve. Patients with urethral stricture need to be followed up at regular intervals. For structural disorders, congenital deformities, infection-related causes, and tumor masses that narrow the urethral diameter, surgery is necessary and treatment is usually carried out by a urologist specializing in the field. Urethral stricture may be caused by a congenital defect or by trauma after birth. However, it is most often seen in male patients and at older ages. According to research, men over 55 years of age are the group in which urethral stricture is most commonly seen.. The main causes are usually surgery-related trauma, stone formation, tumors, and narrowing due to prostate enlargement. In some patients, this condition can affect sexual function. Especially continuous urinary leakage during the day and the feeling of a full bladder after urinating can cause discomfort. In men, this may lead to erectile difficulties, and in women, difficulty reaching orgasm. In addition, patients with urethral stricture may experience pain during intercourse. Urethral stricture usually progresses with symptoms that prompt patients to visit a clinic, while in some patients it is a problem that continues without symptoms. With early diagnosis and treatment by expert surgeons, urethral stricture can be stopped before it progresses. If you notice a few of the symptoms of urethral stricture in yourself or others around you and suspect the disease, you can easily make an appointment and consult our specialist physicians for a detailed examination.