What is urethral stricture disease?

Gendered terms are used here to talk about anatomy and health risk. Please use this information in a way that works best for you and your provider as you talk about your care.

The urethra is the tube that carries urine from the bladder out of the body. In a woman, the urethra's opening is in front of the vagina. In a man, it is at the tip of the penis.

Normally urine flows freely through the urethra. But if scar tissue forms there, the urethra becomes narrowed or blocked. This is called a urethral stricture. This condition can slow urine flow through the urethra. This can lead to problems with peeing (urinating). It can also cause urinary tract infections and prostate swelling or infections. A full blockage can cause urine to back up and result in a kidney infection.

A man’s urethra is longer than a woman’s. Because of this, men are much more likely to have this condition. It is rare in women.

What causes urethral stricture disease?

A blockage of the urethra is often caused by scar tissue. This may occur due to:

• Injury due to a car or bike accident

• Sexually transmitted infections

• Inflammatory disease

• Prostate surgery

• Complications from using a tube (catheter) to drain urine

• Surgery to remove kidney stones

In many cases, the cause is unknown.

What are the symptoms of urethral stricture disease?

The symptoms of urethral stricture disease include:

• Slow urine flow or a urine stream that is split or that sprays out

• Urine leakage or dribbling (incontinence)

• Can't empty the bladder fully

• Pain when peeing

• Pain in the pelvis or lower belly (abdomen)

• Needing to pee more often than normal

• Blood in the urine

• Urinary tract infection

• Blood in semen

• Trouble ejaculating

• Penis swelling

How is urethral stricture disease diagnosed?

Your primary healthcare provider will refer you to a doctor who specializes in diseases of the urinary tract (a urologist). They will do a physical exam and take your health history. You may also need tests such as:

• X-rays or ultrasound. These imaging tests are done to look at the urethra.

• Urethroscopy. This test looks at the lining of the urethra. It uses a thin, flexible tube (urethroscope) with a tiny camera on the end. The healthcare provider can see the stricture.

• Retrograde urethrogram. For this test, a contrast dye is put into the urethra. The dye can be seen on an X-ray. This lets the provider see where the stricture is, its size, and how severe it is.

How is urethral stricture disease treated?

There are no medicines to treat this condition. Instead there are several kinds of procedures. The procedure that you have will depend on the size and location of the stricture. You may need one or more procedures, depending on your situation.

• Urethral dilation. This is the simplest type of treatment. It is a procedure to widen (dilate) the urethra. This can be done by inflating a small balloon in your urethra. Or small metal rods may be used. But stretching the urethra does not fully solve the problem. This procedure often needs to be repeated. If you have strictures that come back too often, you may decide to insert a small catheter each day instead.

• Dilation with drug-coated balloon. This procedure uses a drug-coated balloon to widen (dilate) the urethra and deliver medicine directly to the area. The medicine prevents scar tissue from forming and helps prevent the stricture from coming back. This procedure is an option for certain types of urethral strictures.

• Urethrotomy. This procedure uses a thin, long tube (cystoscope). The scope has a tiny blade on the end. This is used to cut into the scar tissue and widen your urethra. A catheter may also be put into the urethra to help it heal.

• Surgery to rebuild the urethra (urethroplasty). This is reconstructive surgery to remove the stricture and rebuild the affected part of the urethra. There are several types of procedures available. Some of these may need to be done in stages. Talk with your healthcare provider about which procedure may be right for you.

• Urinary diversion. Urine is given a new route out of the body to bypass the urethra. This may mean having a catheter that is replaced each month. Or it may mean having a procedure done. This may be an option if you are not healthy enough to have major reconstructive surgery. It may also be advised if other treatments have not worked.

It’s possible for urethral strictures to come back, even after surgery. So it’s important to follow up with your urologist after treatment. You will see them for physical exams and have X-rays done if needed.

In some cases a stricture may come back but not require more treatment. But if you have a blockage after treatment, you may need a dilation or urethrotomy. Sometimes surgery may need to be done again.

What are possible complications of urethral stricture disease?

Over time, this condition can cause urinary tract infections, blood in the urine, lasting bladder damage, urine backup in the kidneys, or kidney damage.

Key points about urethral stricture disease

• Urethral stricture disease is a narrowing or blockage of the urethra.

• It happens when scar tissue forms in the urethra.

• This condition can slow urine flow through the urethra. It can lead to problems with peeing. It can also cause urinary tract infections and prostate swelling or infections.

• It is much more common in men.

• There are several kinds of treatment procedures available. But urethral strictures can come back, even after surgery.

• No matter the treatment, it's possible for strictures to return. Be certain to keep all follow-up appointments with your urologist.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is advised. and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.