Urethral stricture

Overview of urethral stricture

A urethral stricture is a condition in which the urethra, the tube that carries urine (pee) out of the body, becomes narrowed. In people with a penis, the urethra extends from the bladder to the opening at the tip of the penis (called the urethral meatus). In people with a vagina, the urethra runs from the bladder to an opening located just in front of the vagina. As the urethra becomes narrower, urine has more difficulty passing through.

Urethral strictures occur in approximately 1% of people with a penis. They are much less common in people with a vagina.

Causes

Scar tissue that causes narrowing of the urethra can develop for several reasons, including:

Medical procedures that involve inserting instruments, such as an endoscope, into the urethra
Use of a urinary catheter to drain the bladder
Injury or trauma to the urethra or pelvic region
An increased prostate or previous surgery to treat an increased prostate.
Cancer affecting the urethra or prostate
Sexually transmitted infections (STIs)
Radiation therapy involving the pelvic area
Lichen sclerosus, a skin condition that causes thin, patchy and discoloured skin, most commonly in the genital region

Signs and symptoms

A urethral stricture begins to cause symptoms when the narrowing becomes severe enough to reduce the flow of urine. This can make urination difficult and may increase the risk of urinary tract infections (UTIs) and prostate infections.

Common signs and symptoms include:

Blood in the urine or dark-colored urine
Blood in the semen
A slow or weak urine stream
A urine stream that sprays or splits
Pain or burning during urination
Lower abdominal pain
Leakage of urine from the urethra
Recurrent UTIs in men
Swelling of the penis
Loss of bladder control (urinary incontinence)

Diagnosis

To diagnose a urethral stricture, your healthcare provider will review your symptoms and medical history and perform a physical examination. Additional tests may be recommended to determine the location, length, severity and underlying cause of the stricture. These tests may include:

Urine tests: Used to detect infection, blood or cancer cells in the urine
Urinary flow test: Measures the speed and strength of urine flow to assess how well urine passes through the urethra
Urethral ultrasound: It helps determine the length and extent of the urethral narrowing.
Pelvic ultrasound: Checks whether any urine remains in the bladder after urination, indicating incomplete bladder emptying
Pelvic magnetic resonance imaging (MRI) scan: Provides detailed images of the pelvic structures to evaluate the surrounding tissues and any associated abnormalities
Retrograde urethrogram: A specialised X-ray test in which contrast dye is injected into the urethra to identify the location, length and severity of the stricture, as well as any injury to the urethra
Cystoscopy: Involves inserting a thin, flexible tube with a camera (called a cystoscope) into the urethra to examine the inside of the urethra and bladder directly

Treatment

Currently, there are no medications that can cure urethral strictures. The treatment for a urethral stricture depends on the location, length, severity of the narrowing and the amount of scar tissue present. The main treatment options include:

Urethral dilation

Urethral dilation is usually performed under local anaesthesia. The narrowed section is gradually stretched using specially designed dilators ("sounds") or a balloon catheter. Some balloons are coated with medication that may reduce the risk of the stricture recurring. If the narrowing returns, some patients may be taught intermittent self-catheterisation to help keep the urethra open. Possible complications include bleeding, infection or the formation of a false passage within the urethra.

Urethrotomy

During a urethrotomy, a cystoscope is inserted into the urethra to locate the stricture. A small knife or laser is then used to make an incision through the scar tissue, widening the narrowed area. A urinary catheter is often left in place for a short period to keep the urethra open while it heals. The duration of catheterisation depends on the length and severity of the stricture.

Urethroplasty (Open Surgery)

Urethroplasty is considered the most effective long-term treatment for many urethral strictures. The surgical technique is selected based on the location, length, and complexity of the narrowing. The two main types are:

Anastomotic urethroplasty: This procedure is typically used for short strictures. The surgeon removes the scarred segment and reconnects the healthy ends of the urethra. It is commonly performed as an outpatient procedure or requires only a short hospital stay. A catheter remains in place for approximately 10–21 days and is removed after imaging confirms proper healing.
Substitution urethroplasty: Longer or more complex strictures may require reconstruction using healthy tissue from another part of the body. These procedures are usually performed by surgeons with specialised expertise and have high success rates. Types include:Free graft: Tissue, most commonly from the inside of the cheek (buccal mucosa) or occasionally penile skin, is used to repair or enlarge the narrowed urethra. Patients typically require a short hospital stay and catheterisation for 2–3 weeks.Skin flap: Skin from the penis is rotated to reconstruct the urethra. This technique is generally reserved for severe or extensive strictures and requires advanced reconstructive surgical expertise.Staged urethroplasty: Used when local tissues are unsuitable for a single-stage repair. In the first stage, the urethra is opened and a graft is placed, allowing urine to pass through a temporary opening while the graft heals over several months. In the second stage, the healed graft is shaped into a new urethra, and a catheter is left in place for 10–21 days during recovery.Perineal urethrostomy: Perineal urethrostomy creates a permanent urinary opening in the perineum, allowing urine to bypass the diseased portion of the urethra. This option is generally recommended for men with extensive or complex urethral strictures that cannot be successfully reconstructed. After the procedure, urination is performed while sitting.

Prevention

Avoid trauma to the urethra and pelvis
Take care during self-catheterisation
Use plenty of lubricating jelly
Use the smallest suitable catheter for the shortest duration
Prevent STIs
Reduce the risk by using condoms and avoiding sexual contact with infected partners
Seek prompt antibiotic treatment if an infection occurs. Urethral strictures are not contagious, but STIs are

Complications

Without treatment, urination problems are likely to continue and may worsen over time. Complications can include

Urinary tract or testicular infections
Urinary stones
Urinary retention (inability to pass urine), which may lead to bladder enlargement and kidney damage.

Recovery

Recovery time depends on the type of treatment received. Less invasive procedures, such as urethral dilation, may relieve symptoms within a few days, while recovery after surgery can take up to 8 weeks. Your healthcare provider will advise you on the expected recovery based on your treatment.

With appropriate treatment, urethral strictures generally have a good outcome. However, scar tissue may recur and additional treatment may be needed. Regular follow-up appointments are important to monitor healing and detect any recurrence of the stricture.

When to contact a doctor

Consult a healthcare provider if you experience symptoms of a urethral stricture. After treatment, attend regular follow-up visits to monitor healing and check that the stricture has not returned. If symptoms continue, further treatment may be recommended.