Urethral Stricture

A urethral stricture is a narrowing of the urethra, the tube that carries urine out from the bladder, caused by scar tissue. It occurs almost exclusively in men, because the male urethra is long and exposed to injury.

The scar restricts the flow of urine, leading to a weak stream, incomplete emptying, infections and, in time, damage to the bladder or kidneys. Stretching or cutting the scar brings quick relief, but the narrowing often returns. Open reconstruction, called urethroplasty, offers the highest long-term success.

Symptoms

• A weak, slow or spraying urine stream
• Straining and a prolonged time to empty the bladder
• A feeling that the bladder has not emptied, with dribbling afterwards
• Passing urine frequently and urgently
• Repeated urinary infections, prostatitis or epididymitis
• Pain on passing urine or on ejaculation, and reduced force of ejaculation
• Blood in the urine or semen
• Sudden inability to pass urine at all

Causes and risk factors

The scar forms after injury or inflammation of the lining of the urethra. Common causes are catheterisation and instruments passed through the urethra, such as during prostate surgery, straddle injuries to the perineum, pelvic fractures in road accidents, previous surgery for hypospadias, lichen sclerosus affecting the opening and the front part of the urethra, radiotherapy and, less commonly today, sexually transmitted urethritis. In a considerable number of men no cause is identified. The longer the stricture and the more often it has been cut, the denser the scar tends to become.

How it is diagnosed

• Urine flow test and residual measurement: A flat, prolonged flow curve and urine left in the bladder on ultrasound suggest an obstruction.
• Retrograde and voiding urethrogram: X-rays with contrast that show the position and length of the stricture. This is the key test for planning surgery.
• Flexible cystoscopy: Shows the narrowing directly.
• Ultrasound of the urethra: Measures the depth of the scar in strictures of the bulbar urethra.
• Urine culture and kidney tests: Performed before any procedure.

Treatment options

• Dilatation: Gradual stretching with dilators or a balloon. It is simple, but recurrence is frequent. Some men maintain the result with self-catheterisation.
• Optical urethrotomy: The scar is cut from inside through an endoscope. It is reasonable once for a short bulbar stricture of less than about 2 cm. Success falls sharply when it is repeated.
• Drug-coated balloon: A paclitaxel-coated balloon for short recurrent bulbar strictures. Medium-term results are promising, but long-term data are limited.
• Excision with end-to-end anastomosis: The scar is cut out and the healthy ends are joined. It is used for short bulbar strictures and has success rates of around 90 percent.
• Buccal mucosa graft urethroplasty: A strip of lining from the inside of the cheek widens longer strictures or those in the penile part. It is done in one stage or two. Success is around 80 to 90 percent.
• Pelvic fracture urethral repair: A specialised reconstruction performed some months after the injury.
• Perineal urethrostomy: A permanent opening behind the scrotum for very complex cases or for men who choose it.

When it is urgent

Being unable to pass urine, with a painful and swollen lower abdomen, is an emergency. Go to the nearest hospital for drainage of the bladder, which may require a tube placed through the abdominal wall. Fever and shivering with urinary symptoms, or swelling and pain in the scrotum or perineum, also need urgent care.

Travelling to Türkiye for treatment

Urethroplasty is a specialised operation with markedly better results in the hands of surgeons who perform it regularly, so it is a sound reason to travel. Allow about 2 to 3 weeks on site if you wish to have the catheter removed and the check X-ray done there. The catheter typically remains for 2 to 3 weeks. Alternatively, you may fly home with the catheter in place by agreement and return, or have it removed locally. Bring your urethrogram images and the details of every previous procedure. Avoid having any dilatation or urethrotomy in the 3 months before surgery, so that the full extent of the scar can be seen.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions