Trouble urinating can be uncomfortable to say the least. Even without pain, slowed or difficult urination may be a symptom of something more serious. One of those more serious conditions is urethral stricture.
The urethra is the tube that allows urine to pass out of the body. Urethral stricture is an abnormal narrowing of the urethra due to swelling or scarring. Urethral stricture can, but does not always, cause pain.
Causes of Urethral Stricture
The urethra runs from the bladder floor to the external urethral orifice — the opening in which urine is drained from the body. In females, the urethra is much shorter than in males. The female urethra is about 1.5 inches long. Conversely, it can be an average of 7 to 8 inches long in men.
The longer tube puts men at a much higher risk of urethral strictures than women. In fact, strictures are rare in women. Up to 15% to 20% of men, on the other hand, experience a urethral stricture.
There are numerous potential causes of urethral strictures, mostly from infections or injuries that result in swelling or scar tissue.
Causes may include:
- Sexually transmitted infections (STIs).
- Surgical procedures that included the use of a catheter.
- Kidney stone removal.
- Pelvic injuries.
- Repeated urinary tract infections.
- An enlarged prostate.
- Radiation therapy during prostate and other pelvic cancer treatment.
- Congenital malformations (rare).
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Urethral Stricture Symptoms
Any trouble with the flow of urination for an extended period of time can cause damage to the kidneys. It is important to seek medical treatment if you experience blocked or slowed flow of urination.
In addition, the following can also be symptoms of urethral stricture:
- Incomplete emptying of bladder.
- Pain or strain when urinating.
- Slow, decreased, or spraying urine stream.
- More frequent urination.
- Increased urge to urinate.
- Dark or bloody urine.
- Blood in semen (men).
Urethral Stricture Diagnosis
To diagnose urethral stricture, a doctor will start with a physical exam, but may need imaging or other tests to find the root of the problem.
These can include:
- Urinalysis — a test of your urine.
- Pelvic or urethral ultrasound — among other things, used to detect urine left in the bladder after urination.
- Urethroscopy — to see the inside of the urethra.
- Retrograde urethrogram — a diagnostic test that uses an X-ray to detect structural issues throughout the length of the urethra.
Treatment Options for Urethral Stricture
Treatments for urethral stricture generally have positive outcomes but may require monitoring or even repeat procedures over time.
Treatment depends on the type, location, and length of the blockage. No treatment may be necessary in some cases where the stricture is not causing pain while urinating or leaving urine in the bladder. Treatments range from minimally invasive to surgical options.
Treatment can include:
- Dilation. Dilation stretches the stricture using gradually larger dilators, or a special balloon on a catheter. This procedure is not a cure and may need to be repeated.
- Urethrotomy. A urethrotomy uses a special scope (cystoscope) that is inserted into the urethra to find the stricture. Then, a tool such as a blade or laser is used to cut the stricture.
- Urethroplasty. A urethroplasty is a surgery performed on the urethra to reconstruct or remove the part of the urethra with the stricture.
Staying away from the most common causes of urethral strictures will put you at lower risk. The most important way to prevent it is to take care not to catch any STIs. Chlamydia and gonorrhea are the most common causes of strictures among STIs. Take caution to avoid risk of STIs.
Additionally, in cases where self-catheterization is necessary, take extra precautions to prevent infection, such as using clean hands, the smallest possible sterile catheter, and lubricating jelly.
Urology at UPMC
If you are in need of specialty services for a urethral stricture or any other urinary tract issue, find a urologic surgical specialist at UPMC. UPMC offers fellowship specialty-trained urologic surgeons in the management of male urethral stricture disease.
The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs, including erectile dysfunction, kidney stones, urinary incontinence, prostate cancer, and more. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. To find a provider near you, visit our website.