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Definition
A urethral stricture is a scar in or around the urethra, which is
the tube that drains urine from the bladder. A stricture can block the flow
of urine.
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What is going on in
the body?
Urethral strictures are more common in men. This is because
women's urethras are shorter and less prone to disease. Anything that harms
the urethra can cause a stricture. Rarely, a person can be born with
urethral strictures. As the opening of the urethra narrows, it is
increasingly more difficult for urine to flow through it. This can lead to
the bladder becoming enlarged and weakened.
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What are the signs and symptoms of the condition?
Symptoms of a urethral stricture include:
- decrease of in the force of the urine stream, which is the most
common complaint
- spraying of the urine stream, which occurs if the stricture is
near the outer end of the urethra
- infection of the prostate, such as acute prostatitis, chronic
prostatitis, or non-bacterial prostatitis
- infection of the epididymis, such as acute epididymitis or
chronic epididymitis
- infection of the bladder, such as a urinary tract infection
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What are the causes and risks of the condition?
The following conditions can lead to urethral
strictures:
- infection. Gonorrhea infection of the urethra used to be the
most common cause of urethral strictures. However, the development of
effective antibiotics has made this complication rare today. It is unclear
if infections from chlamydia and ureaplasma cause strictures. Common
urinary tract infections such as bacterial cystitis do not cause
strictures.
- external injuries, such as a straddle injury. This occurs when
a hard object strikes the base of the perineum, such as on a bicycle.
Pelvic fractures can also lead to strictures of the urethra.
- open or endoscopic surgery. Surgical procedures involving the
urethra can result in stricture formation. Rarely, insertion of a urinary
catheter can cause this problem.
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What
can be done to prevent the condition?
Protecting against sexually transmitted diseases such as gonorrhea
that cause urethral infections can prevent some urethral strictures.
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How is the
condition diagnosed?
The first diagnosis of strictures is made when the healthcare
provider is unable to pass a catheter through the urethra. Strictures may
also be suspected based on the person's symptoms and medical history. The
diagnosis is confirmed with endoscopy or another test known as retrograde
urethrography. This involves injecting a contrast agent into the urethra so
that it shows up on an x-ray.
After initial diagnosis, the next step is to determine the length and
location of the stricture. This can be done with endoscopy, urethral x-ray,
or ultrasound.
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What are the long-term effects of the condition?
Uretheral strictures that do not completely block the urethra can
limit urine flow. This can lead to urine retention and cause the bladder to
enlarge.
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What are the risks
to others?
Although, urethral strictures are not contagious, the underlying
cause may be contagious, such as sexually transmitted diseases.
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What
are the treatments for the condition?
Urethra strictures are often opened up by inserting catheters,
with or without balloons on the end, into the urethra. This method is
effective in treating short strictures but not as useful for longer ones.
The next step is a procedure called endoscopic internal urethrotomy. This
involves cutting open the stricture from the inside using a knife, laser, or
electrocautery. It is done through an endoscope. Most of the time this
technique works only for short to medium length strictures located in the
front of the urethra.
The most effective technique is open surgery to cut out the stricture. The
spliced ends of the urethra are then reattached. Sometimes a graft is used
to patch the excised segment. For people with severe strictures who choose
not to undergo open surgery, permanent catheters or stents can be inserted
into the urethra.
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What happens
after treatment for the condition?
Strictures are prone to return after dilation with catheters or endoscopic
removal. Open surgery to repair the stricture carries the risks of bleeding, infection,
and damage to the penis or other pelvic structures.
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How is the condition
monitored?
A person treated for urethral strictures should have follow-ups for at least one
year. This is to watch for reoccurrence of the stricture. The primary monitoring test used
is uroflowmetry, a test which measures the rate of urine flow during urination.
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