Aashray urology institute

Urethral Stenosis/Urethral Stricture

Urethral Stenosis or Urethral Stricture occurs when a scar from swelling, injury, or infection blocks or slows the flow of urine in the urethra or causes urine to back up in the urinary tract. If left untreated, this may lead to kidney damage. 
Urethral-stenosis overview
Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.
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What Is Urethral Stenosis or Urethral Stricture?

The urethra is the thin tube and its main job is to pass or carry urine from the urinary bladder out of the body. Urethral stricture or urethral stenosis is when the urethra gets narrower or the flow of urine gets slower or blocked due to swelling, injury, or infection. This can cause urine to back up in the urinary tract and obstruct the bladder’s function or ability to urinate which may lead to kidney damage. This narrowing or blockage can occur anywhere in the urinary tract, from the bladder to the opening of the urethra into the vagina.

Urethral Stenosis in female
Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.

What Are The Causes Of Urethral Stenosis or Urethral Stricture?

The following are the causes of Urethral Stenosis or Urethral Stricture - 

1. Urethral Manipulation or Trauma

The most common cause for Urethral Stenosis or Urethral Stricture is urethral manipulation or damage from a urethral catheter, urology procedure, surgical tools etc. Along with external damage or trauma, radiation that is used to treat certain gynecological, urological, or gastrointestinal tumors can also contribute to urethral stricture. 

2. Inflammatory Conditions

Another common cause of Urethral Stenosis or Urethral Stricture is bacterial infections resulting in inflammation in the urethra. Other conditions/ causes of inflammation include untreated sexually transmitted infections (STIs) such as gonorrhea and chlamydia and a condition called balanitis xerotica obliterans. Severe inflammation of the urethra can cause a breakdown and subsequent scarring of normal tissue. 

3. Lack of Estrogen

Estrogen deficiency can shrink the opening of the urethra, making it narrower.  

What Are The Symptoms Of Urethral Stenosis or Urethral Stricture?

Urethral stricture is rare among women and highly symptomatic. The symptoms for it are as follow: 

  1. Problems with urinating, painful urination, or inability to urinate
  2. Not able to empty the bladder completely or getting that feeling after urination
  3. UTIs
  4. Bloody urine or change of color in urine
  5. Slow, interrupted urine stream
  6. Abdominal pain  
  7. Loss of bladder control
  8. Frequent urination
  9. Urinary incontinence (urge)

How is Urethral Stenosis or Urethral Stricture Diagnosed?

During the health checkup, the doctor will discuss your medical history to understand your case and diagnose the underlying cause of urethral strictures. Also, you will be asked to describe the symptoms, your observations, when it started etc. The doctor may suggest the following tests in case the causes and symptoms are not diagnosed during the initial health checkup - 

1. Basic Evaluation

This includes physical examination and urine and blood tests. During the physical examination, the doctor looks at the meatus and other pelvic organs for any abnormalities.

2. Urethroscopy

In this test, thin, bendable, lubricated scope with a light is inserted into the urethra to see the location of the urethral stricture or the narrowed area. 

3. Cystoscopy

A small scope is inserted into the urethra and placed into the bladder to look for scarring and narrowing of the urethra. 

Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.

4. Imaging Tests

Tests like CT scans, MRIs, ultrasounds are taken before and after passing urine and help the doctor to view the urethra and surrounding structures and determine the cause and right course of treatment.  

5. Uroflowmetry

During this test, you will be asked to urinate in a commode like a machine that can measure and record flow rates. This is done to determine the speed of the flow. 

6. Micturating cystourethrogram (MCU)

This is another imaging test, however, it is done when the results of the basic tests are abnormal. In MCU, the contrast material is injected into the full bladder with the help of a needle to puncture it. After that, the x-rays are taken while passing urine. This helps the doctor to study the urethra. By this imaging test, urethral stenosis can be differentiated from other conditions with similar symptoms. 

7. Urethral Calibration:

In this test, a specific size catheter is passed through the urethra into the bladder to check if there’s any resistance or catheter can easily advance into the bladder. The position at which the tube gets held up is noted to determine the presence of urethral stricture. 

What Are The Treatment Options For Urethral Stenosis or Urethral Stricture?

The treatment for urethral stenosis is decided based on their location, symptoms, causes, severity, and overall health of the patient.  The treatment options are as follow - 

1. Watchful Waiting

In cases where there are no significant symptoms, the doctor may recommend watchful waiting to see whether it heals.

2. Suprapubic Catheter

In this treatment, a special catheter is inserted into the urinary bladder through the abdomen, above the pubic bone. This treatment is recommended in cases where one has significant urinary retention. 

Suprapubic Catheter
Suprapubic Catheter Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.

3. Dilation

This is a simple and effective treatment that is usually recommended as an initial step. Dilation basically means enlarging the stricture with gradual stretching. In this treatment, a metal tube or sound (dilators) is used to stretch the urethra and break the scar tissue. So, the urethra can heal with a wider caliber. This treatment needs to be repeated often which can cause side effects like bleeding and infection. Also, in cases where the stricture recurs easily and quickly, a special catheter is given to prevent it from coming back. 

4. Urethrotomy

In this procedure, a laser, knife, or scalpel is used to cut the urethral stricture and create a gap. The procedure begins with inserting a scope or cystoscope for guidance. The scope is then moved along the urethra until the stricture is found. After cutting the stricture, a catheter is placed into the urethra to hold the gap open and let it heal.

5. Open surgical removal

This is the most invasive procedure to treat urethral stenosis. In this procedure, a small surgery is performed on the vagina where the urethra is expanded through the scarred area using a small piece of the lining of the mouth (buccal graft). A catheter is used to maintain the gap and removed usually after the 3 weeks post-surgery. The mouth, cheek area from where the fat is taken, also heals very quickly. 

What To Expect After The Treatment?

As urethral stenosis or urethral stricture can come back easily, follow-ups are especially important. Post-surgery, the catheter will be removed as planned. During follow-ups, physical examinations and x-rays will be conducted. In addition to these, sometimes a flow test and a scope test may also be performed to check on the recovery process. 

Book Appointment

If you have any questions or doubts about any Urethral Stenosis/ Urethral Stricture treatment or any other treatment available at Aashray Urology Institute, book a consultation with Dr. Ashit Shah and he will expertly guide you on the same. 
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Dr. Ashit Shah

Dr. Ashit Shah

Meet the doctor

Dr. Ashit Shah

MB, MS, DNB(Urology), DLU(France)

Dr. Ashit Shah

Dr. Ashit Shah

Dr. Ashit Shah is a senior consultant Urologist heading Aashray Urology Institute. After completing his M.B.B.S. and M.S. in General Surgery, he was awarded Diplomate of National Board (D.N.B.) in Genito-Urinary Surgery by the National Board of Examinations, New Delhi. He earned his Diplomate in Laparoscopic Urology from Louis Pasteur University, Strasbourg, France in the year 2006. Dr. Shah has a special interest in Endo-Urology, especially Urolithiasis i.e. Urinary Stone Disease. Having spent more than 27 years in the profession of Urology, he has experience of over 75,000 urological consultations and more than 15,000 surgeries. Being counted amongst the torch bearers of ethical and transparent medical practice in the city of Vadodara, he was conferred ‘Inspiring Urologist Award’ for the year 2019 by The Economic Times.

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