From the Guidelines
Female urethral stricture is most commonly caused by iatrogenic factors, such as painful or traumatic catheterization or multiple urethral dilations, which can lead to fibrosis from bleeding and extravasation 1.
Causes of Female Urethral Stricture
The causes of female urethral stricture can be categorized into several groups, including:
- Iatrogenic causes: urethral dilation, catheterization, urethral surgery, and pelvic radiation therapy
- Traumatic causes: direct injury to the urethra from pelvic fractures or childbirth
- Inflammatory conditions: lichen sclerosus, which causes chronic inflammation and fibrosis of genital tissues
- Infections: recurrent urinary tract infections, which can lead to inflammation and subsequent scarring of the urethral lining
- Other less common causes: malignancy, congenital abnormalities, and autoimmune disorders affecting the urethral tissue
Pathophysiology and Diagnosis
The pathophysiology of female urethral stricture involves inflammation leading to fibrosis and narrowing of the urethral lumen, which restricts urine flow 1. This condition is often underdiagnosed in women due to its relative rarity compared to male urethral strictures and because symptoms like weak urinary stream, incomplete emptying, and recurrent UTIs overlap with other urological conditions. Proper diagnosis typically requires a combination of clinical evaluation, uroflowmetry, and imaging studies such as voiding cystourethrography or urethroscopy.
Treatment Options
While the question focuses on the causes of female urethral stricture, it is worth noting that the best treatment option for urethral stricture in female patients is urethroplasty using oral mucosa grafts or vaginal flaps rather than endoscopic treatment 1.
From the Research
Female Urethral Stricture Causes
- The most common etiologies of female urethral stricture disease are traumatic injury, iatrogenic injury, and inflammatory disease resulting in periurethral fibrosis 2
- Traumatic injury and iatrogenic injury can lead to the formation of scar tissue, which can cause the urethra to narrow and lead to stricture formation
- Inflammatory disease, such as urethral inflammation or infection, can also cause scarring and stricture formation
Risk Factors
- Previous urethral instrumentation is a risk factor for female urethral stricture, with 301 patients having previous urethral instrumentations in one study 3
- Pelvic fractures can also cause injury to the urethra, leading to stricture formation, although this is more commonly associated with male urethral injuries 4, 5
Diagnosis and Symptoms
- Hallmark symptoms of female urethral stricture disease include frequency, urgency, dysuria, hesitancy, slow stream, incontinence, and recurrent urinary tract infections 2
- Diagnosis is usually based on symptoms, meatal appearance, and difficult instrumentation of the patient, with other testing such as urodynamics, voiding urography, or cystoscopy also being helpful 2
- A combination of tests is often used for diagnosis, as none is singularly conclusive 3