Urethral stricture

Overview

A urethral stricture is a narrowing of the tube (urethra) that carries urine out of the body. This can make urination difficult or uncomfortable.

It is not extremely common, but it affects many men, especially as they get older or after certain injuries or infections.

Primarily affects men, but can occur in anyone with a urethra. It is more common in older adults and those with a history of pelvic injury, catheter use, or sexually transmitted infections.

Symptoms

Common symptoms

• Weak urine stream or trouble starting to urinate
• Feeling like the bladder is not empty after urinating
• Frequent or urgent need to urinate
• Urine that sprays or dribbles after you finish
• Pain or burning when urinating

Symptoms in children

• Children may have the same symptoms but might not tell you. Look for signs like crying when urinating, wetting the bed after being potty-trained, or holding in urine.

Symptoms in older adults

• Older adults may have more trouble starting to urinate, or they may not be able to urinate at all (urinary retention). This is an emergency.

Causes

Main causes

• Injury to the urethra from accidents, falls, or medical procedures like catheter placement
• Infections, especially sexually transmitted infections such as gonorrhea
• Inflammation from conditions like lichen sclerosus (a skin condition)

Risk factors

• Previous injury to the pelvic area or urethra
• History of sexually transmitted infections
• Previous use of a urinary catheter
• Pelvic surgery, especially prostate surgery

When to see a doctor

See a doctor urgently if:

• If you cannot urinate at all
• If you have severe belly or back pain with urinary symptoms
• If you have a fever with your urinary symptoms

Book a routine appointment if:

• If you notice any changes in your urination that last more than a few days
• If you have pain, a weak stream, or need to urinate often

Diagnosis

Your doctor will start by asking about your symptoms and medical history. They may do a physical exam and a urine test. Special tests can look inside the urethra to see if there is a narrowing.

Tests that may be done

• Urine test to check for infection or blood
• Cystoscopy – a thin tube with a camera is passed into the urethra to see the narrowing
• Ultrasound of the bladder and kidneys to check for backup of urine
• X-ray with dye (urethrogram) to show the shape and length of the narrowing

What to expect at your appointment

Most tests are done in a clinic or hospital and can be a little uncomfortable but are usually not very painful. Your doctor will numb the area to help. You can go home the same day.

Treatment

Treatment depends on where the stricture is, how long it is, and how severe your symptoms are. Options range from simple procedures to surgery.

Self-care at home

• Drink plenty of water to stay well hydrated
• Avoid holding your urine for long periods
• Practice good hygiene to reduce the risk of infections

Medical treatments

Your doctor may suggest a procedure to widen the stricture (called dilation) or to cut the narrowed part (called urethrotomy). These are often done with local or general anesthesia and may not need an overnight stay. Sometimes a temporary tube (catheter) is left in place to help the urethra heal.

When is surgery considered?

If the stricture is long, keeps coming back, or if other treatments haven't worked, surgery (such as urethroplasty) may be recommended. This can often provide a long-term or permanent fix.

Living with this condition

Follow your treatment plan and attend regular check-ups. If you use a catheter, keep it clean. Notice any changes in your symptoms and tell your doctor.

Lifestyle tips

• Avoid activities that could cause injury to the pelvic area, like certain contact sports if advised by your doctor
• If you have a catheter, clean it and the surrounding area as instructed
• Keep in touch with your healthcare team

Diet and exercise

There are no special dietary restrictions, but staying hydrated is important. Gentle exercise is fine, but avoid heavy lifting or straining if it causes discomfort. Listen to your body.

Mental health and emotional wellbeing

Living with a urinary problem can be frustrating and stressful. It may affect your confidence or social life. It is okay to feel this way, and asking for help is a sign of strength.

Prevention

Not all cases can be prevented, but you can lower your risk by using condoms to avoid sexually transmitted infections, and by being careful to avoid injury to the pelvic area. If you have a catheter, follow hygiene instructions closely.

Complications

If left untreated

• Urinary tract infections (UTIs) that keep coming back
• Kidney damage from urine backing up into the kidneys
• Bladder stones (hard mineral deposits in the bladder)
• Complete blockage of urine (acute urinary retention) – a medical emergency

Long-term outlook

The outlook is very good with proper treatment. Most strictures can be fixed or managed so that you can urinate normally. Catching it early and following your doctor's advice can help prevent serious problems and improve your quality of life.

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