What are the causes of urethral stricture?

From the Guidelines

Urethral stricture is primarily caused by iatrogenic factors, trauma, and certain medical conditions, with the most common causes including painful or traumatic catheterization, multiple urethral dilations, blunt pelvic trauma, and obstetric complications. The main causes of urethral stricture can be broken down into several categories, including:

• Iatrogenic factors: Such as painful or traumatic catheterization, multiple urethral dilations, and previous surgeries, which can lead to fibrosis from bleeding and extravasation 1
• Trauma: Blunt pelvic trauma, obstetric complications, particularly cephalopelvic disproportion, can cause urethral stricture 1
• Medical conditions: Malignancy, radiation, urethral or vaginal atrophy, recurrent infections, and skin diseases such as lichen planus and lichen sclerosus can also contribute to the development of urethral stricture 1 It is essential to understand these causes to provide proper prevention and treatment, and patients should seek medical attention for any urinary symptoms or after urethral trauma to prevent complications. Proper hygiene, safe sexual practices, and careful catheter use can help reduce the risk of urethral stricture. According to the most recent guideline amendment, urethral stricture disease can be caused by various factors, and identifying the underlying cause is crucial for effective management 1.

From the Research

Causes of Urethral Stricture

• Urethral stricture can be caused by various factors, including:
  • Pelvic fractures from high-energy blunt force trauma, which can lead to pelvic fracture urethral injury 2
  • Iatrogenic injuries resulting from invasive measures such as catheterization or other major surgical measures (prostatectomy or sling operations for continence) 3, 4, 5
  • Blunt or penetrating trauma, such as straddle injuries or gunshot wounds 3, 6, 5
  • Foreign bodies deliberately introduced into the urethra 3
• Urethral stricture can also be a complication of urethral injury, with up to 32% of all urethral injuries being iatrogenic and resulting from catheterization 4
• The most common complication of catheterization in the long-term period is urethral stricture, occurring in 78% of cases 4

Types of Urethral Injuries

• Urethral injuries can be classified into two main types:
  • Anterior urethral injuries, which are often iatrogenic or caused by blunt trauma 3, 6, 5
  • Posterior urethral injuries, which are often caused by pelvic fractures or high-energy blunt force trauma 2, 6, 5

Risk Factors for Urethral Stricture

• The risk of developing urethral stricture is higher in patients with urethral injuries, particularly those caused by pelvic fractures or iatrogenic injuries 2, 4
• The use of certain catheterization techniques and materials can increase the risk of urethral stricture, highlighting the importance of proper catheter insertion technique and the use of additional assets such as anesthetic gels-lubricants 4