What is the Urethra?
The urethra is a tube that carries the urine from the urinary bladder through the penis and out the urethral opening during urination.
What is a Stricture?
Urethral stricture is a result of a scar that forms in the urethra. It may develop due to long-term inflammation or injury to the urethra. Other causes include injury to the penis or scrotum, urinary tract infections, sexually transmitted diseases, placement of urinary catheters, and following surgery or urethral procedures. The scar tissue contracts gradually and reduces the flow across the urinary tube. Often, it is a slow process and symptoms develop long after the initiating event.
How does one suspect a Urethral stricture?
The most obvious symptom is a weak urinary stream which is often accompanied by straining to urinate, pain during urination, and recurrent urinary tract infections. Some patients with severe urethral strictures are completely unable to void, leading to urinary retention which is a medical emergency. Persistently pent-up urine in the bladder may even lead to pressure effects on the kidneys which causes hydronephrosis or even renal failure.
Diagnosis of urethral stricture disease can be done by various non-invasive and invasive tests. Screening tests include urine flow testing – which measures the rate at which one urinates into a collection device. It may be done at the urologist’s office or at home using the novel disposable uroflowmeter (P-flow). These non-invasive tests can indicate the need for further confirmatory testing and procedures. If your doctor suspects a urethral stricture he will request a retrograde urethrogram, which is an X-ray film taken following instillation of dye into your urinary tube to find out the location and length of the stricture. Sometimes you will be asked to pee while taking the X-ray to study the stricture during the urinating process. Cystoscopy is an office procedure that utilizes a small flexible camera that is passed in the penis allowing the doctor to see the inside of the urethra. Before the procedure, a lubricant jelly will be inserted into the urethra to avoid any discomfort from the procedure.
How do we treat a Urethral stricture?
The treatment of urethral stricture is done by endoscopic surgery under anesthesia which includes optical internal urethrotomy done by endoscopic knife or LASER. The scar causing narrowing of the lumen will be cut from within and a urinary catheter will be kept for a few days postoperatively. You may need to practice self-calibration of the urethra after catheter removal to ensure that the stricture segment remains wide and patent. This is an easy and simple to learn the procedure and can be learned with ease. Patients who have a recurrent stricture or severe stricture disease may need open surgery and must discuss the same with your doctor.
What is the outcome of Urethral stricture? Urethral stricture disease has a positive outcome; however, it may happen again. This may require multiple procedures and regular follow up with your urologist. P-flow is a simple test performed at home to monitor the effectiveness of treatment over the stricture disease.