Urethral Strictures
What is the Male Urethra?
The male urethra is a tubular structure that originates from the lower portion of the urinary bladder. After running above the scrotal sac and underneath the penis, the urethra ends at the tip of the penis with the urethral meatus (opening). The function of the urethra is to allow the outlet of urine and seminal fluid. The male urethra can be subdivided into anterior and posterior urethra. The posterior urethra extends from the bladder to the external urethral sphincter and can be divided into the prostatic urethra, which runs inside the prostatic gland, and the membranous urethra located at the level of the external urinary sphincter. The anterior urethra instead extends from underneath the external urinary sphincter to the meatus, which is the opening of the urethra at the tip of the penis. The anterior urethra can be then further subdivided into bulbar, penile, and navicularis urethra.
A urethral stricture is a narrowing of the urethral tube. Since the tube is narrowed, the flow of urine and of the seminal fluid through the tight section can become increasingly difficult, and the patient may find emptying the urinary bladder extremely challenging. If a significant amount of urine cannot be eliminated and remains in the bladder, the risk of urinary tract infections becomes high and if the situation is not corrected, in the long-term, patients can form bladder stones and experience a degree of kidney damage.
What is a Urethral Stricture?
What are the Causes of Male Urethra Strictures?
Male urethral stricture may be due to congenital (you are born with it) abnormalities or caused by trauma, surgery, degenerative skin disease, or infections.
Hypospadias is the most common congenital malformation in which the urethral opening is not positioned on the tip of the penis but instead can be found somewhere on the bottom of the penile shaft. Since the urethra is frequently short and not elastic, during erection, it causes the penis to bend downwards.
Any type of trauma to the urethra can cause a urethral stricture, as the elastic tissue that naturally surrounds the urethral tube is replaced by scar tissue, which, by definition, does not stretch and is stiff.
Sexually transmitted diseases, such as chlamydia and gonorrhea, are well-known causes of urethral strictures.
The most frequent cause of urethral stricture is a degenerative skin disease of the genitalia known as lichen sclerosus. The cause of lichen sclerosus, which is a chronic inflammatory skin disease, is still not well understood. Lichen sclerosus may involve any skin area but in most cases, it affects the genitals. The skin and mucosa affected by lichen sclerosus tend to become progressively harder, thicker, and less elastic.
If the lichen sclerosus affects the glans (the tip of the penis), the urethra is frequently involved and can appear narrowed.
Urethral strictures can be suspected while collecting clinical history and at examination. Frequently, patients complain of weak urine stream, pain during urinating, difficulty to initiate urinating, sensation of incomplete bladder emptying, and recurrent urinary tract infections. A variety of specialised investigations are now available to the clinician to confirm the diagnosis of urethral stricture and to identify the type, position, and length of the stricture.
How are Urethral Strictures Diagnosed?
Which Specialist Investigations are Available in Patients with Urethral Strictures?
Uro-flowmetry. It is a simple investigation that can be performed in the urological outpatient office. The patient is invited to urinate in a special container connected to a computer, which records the volume and velocity of the urine stream. No specific preparation of the patient is required to perform the test, except for a full bladder in order to urinate.
Ultrasonography. This exam is performed after the uroflowmetry to evaluate the urinary bladder volume and assess whether the patient is able to empty the bladder completely. The presence of urine in the bladder after voiding can be related to a urethral stricture.
Urethrography. This radiological investigation is carried out after the injection of dye in the lumen of the urethra. Retrograde and voiding urethrography is the most basic and useful exam to assess the presence, position, and length of a urethral stricture. This exam is necessary to adequately plan the surgical correction of the stricture.
Urethroscopy. This procedure is performed in an operating room with the patient under local or general anesthesia and consists in the introduction of a small camera into the urethra through the external meatus in order to visualize the urethral canal from the inside and inspect the stricture.
How are Urethral Strictures Treated?
A variety of procedures are available to correct the urethral stricture, and the most suitable one depends on the location and length of the stricture and the medical history of the patient.
Urethral Stricture Surgery in London
Urethral strictures have various treatment options, including surgery. Dr. Giulio Garaffa offers advanced urethral stricture surgery procedures and guaranteed outcomes. He is one of the most trusted urology specialists in London and performs over 300 complex penile reconstruction procedures every year.