Urethral Stenosis or Urethral Stricture occurs when the urethra narrows down due to aging or as a result of scar from swelling, injury, or infection. It 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.
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 Stenosis or Urethral Stricture occurs when the urethra narrows down due to aging or as a result of scar from swelling, injury, or infection. It 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.
The following are the causes of Urethral Stenosis or Urethral Stricture -
The most common cause for Urethral Stenosis or Urethral Stricture is Estrogen deficiency. It can shrink the opening of the urethra, making it narrower. This can typically occur in old age.
Another common cause of Urethral Stenosis or Urethral Stricture is bacterial infections resulting in inflammation of the urethra. Other conditions/ causes of inflammation include untreated sexually transmitted infections (STIs) such as gonorrhea and chlamydia. Severe inflammation of the urethra can cause a breakdown and subsequent scarring of normal tissue.
Urethral manipulation or damage from a urethral catheter, urology procedure, surgical tools, etc. can cause urethral stenosis. Besides external damage or trauma, radiation that is used to treat certain gynecological, urological, or gastrointestinal tumors can also contribute to urethral stricture.
Urethral stricture is uncommon among women and is usually symptomatic. It’s symptoms are as follows:
The doctor will first note down your medical history and then make a clinical examination to look at external urinary meatus and other pelvic organs for any abnormalities.
This includes urine and blood tests.
In this test, you will be asked to urinate in a commode like machine that will measure and record your urinary flow rates to determine your urine flow speed. Then the amount of urine remaining in your bladder will be measured by a sonography machine.
The Urologist may ask for an ultrasound of the kidneys and bladder to know the status of upper tracts. Rarely, a CT scan may be asked for to know the status of surrounding pelvic organs.
The treatment for urethral stenosis is decided based on the symptoms, causes, severity, and overall health of the patient. The treatment options are as follow -
In cases where there are no significant symptoms, and the stenosis is not severe, the doctor may recommend watchful waiting to see whether it heals naturally.
You may be given alpha-blocker medicines to see if they help improve your urine flow.
In case of urinary retention (complete blockage of urine), a tube may be passed through the urethra or from the abdomen (suprapubic catheter) temporarily to relieve blockage till definitive surgery is undertaken.
In severe urethral stenosis or that not responding to medical management, an endoscopic blade is used to open up the urethra under vision. The entire urethra and urinary bladder are visualized endoscopically. A catheter is then placed into the urethra to hold the gap open and let it heal.
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 is removed usually after the 3 weeks post-surgery.
As urethral stenosis or urethral stricture can come back easily, follow-ups are especially important. Post-surgery, the catheter will be removed as planned. You may then be taught self calibration to reduce chances of recurrence of urethral stenosis. During follow-ups, physical examinations, and Uroflowmetry will be conducted regularly.
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.
