Page 1 - Urethral Strictures in Men

Urological Health
Urethral strictures in men
A urethral stricture is a narrowing in the bladder outlet that can cause voiding difficulty.
he bladder stores urine produced in the kidneys
Tuntil emptying is appropriate. During urination, the
bladder muscle contracts to expel urine through its
outlet, the urethra. Opening and closing of the urethra
is controlled by muscles that surround it called the
urethral sphincter.
Urine leaves the bladder through a muscular opening,
the bladder neck, into the first part of the urethra
which runs through the prostate (prostatic urethra).
The next segment is the membranous urethra which is
surrounded by a control muscle, the external urinary
sphincter. This sphincter allows one to voluntarily retain
urine and to stop flow during urination. Together, the
prostatic and the membranous portions make up the
posterior urethra, which is approximately 2.5 to 5 cm
(1-2 inches) long.
bladder
prostate prostatic urethra posterior
bulbar membranous urethra
urethra urethra
external urethral
anterior penile sphincter
urethra urethra
Roula Drossis
urethral
meatus
The remainder of the urethra is a channel running
through the penis. The first portion, the bulbar urethra,
is located in the crotch between the legs, while the
penile urethra runs through the shaft of the penis. The
opening at the tip of the penis is called the urethral
meatus. The bulbar urethra, penile urethra and
meatus make up the anterior urethra.
A urethral stricture is a scar in or around the urethra,
which can restrict the flow of urine. Imagine a
narrowing or kink in a garden hose which will slow the
stream of water. A stricture in the urethra can cause
weakening or spraying urine stream, painful urination
and occasionally blood from the urethra.
Stricture disease may occur at any point of the
urethra from the bladder to the urethral opening. The
most common cause of a stricture is an injury to the
urethra. A fall or motor vehicle accident may cause
a pelvic bone fracture with a tearing of the posterior
urethra, which may heal with the formation of a
stricture. A straddle injury, such as striking a bicycyle
cross-bar between the legs, can crush the anterior
urethra causing a stricture. This problem may also
occur from injury to the urethra after placement of a
draininge tube (catheter) or after surgery performed
through the urethra. Occasionally, urethral strictures
may be due to infections. In many cases, however, no
obvious cause can be identified.
When a urethral stricture is suspected, your doctor
may recommend investigations to clarify the
diagnosis. This may include urine tests to identify
blood or infection. The rate and volume of urine flow
can be recorded (uroflowmetry). Several imaging
tests can be used to evaluate the location, length
and severity of a urethral stricture. An X-ray image of
the urethra can be obtained after injecting contrast
“dye” into the channel (urethrogram) to demonstrate
the stricture characteristics. Ultrasound examination
of the urethra may determine the amount of scar
tissue present. Urethroscopy is a procedure where the
the urethra to examine the stricture visually. These tests
doctor gently places a thin, lubricated “scope” into
will help establish the diagnosis and guide treatment.
Treatment options
There are different treatment options for urethral
strictures depending upon the length, location and
degree of associated scar tissue. Options include
enlarging the stricture by gradual stretching (dilation),
cutting the stricture through a “scope” (internal
urethrotomy) and surgical removal of the stricture
with reconstruction of the urethra (urethroplasty).
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