From the Guidelines
Urethral stricture is a narrowing of the urethra that requires medical attention, and its causes and symptoms can be identified through a combination of patient reported measures, uroflowmetry, and ultrasound post-void residual (PVR) assessment, as well as urethro-cystoscopy, retrograde urethrography (RUG), voiding cystourethrography (VCUG), or ultrasound urethrography. The symptoms of urethral stricture include decreased urinary stream, incomplete emptying, dysuria, urinary tract infection (UTI), and rising post-void residual (PVR) 1.
Causes and Symptoms
The causes of urethral stricture can be attributed to various factors, including trauma, infection, and inflammation, which can lead to scarring and narrowing of the urethra. The symptoms of urethral stricture can vary depending on the severity and location of the stricture, but common symptoms include:
- Decreased urinary stream
- Incomplete emptying
- Dysuria
- Urinary tract infection (UTI)
- Rising post-void residual (PVR)
Diagnosis
Diagnosis of urethral stricture can be made through a combination of patient reported measures, uroflowmetry, and ultrasound post-void residual (PVR) assessment, as well as urethro-cystoscopy, retrograde urethrography (RUG), voiding cystourethrography (VCUG), or ultrasound urethrography 1.
Treatment
Treatment options for urethral stricture include urethral dilation, internal urethrotomy, and urethroplasty, with the choice of treatment depending on the severity and location of the stricture, as well as the patient's overall health and preferences 1.
Ongoing Management
For ongoing management, patients with urethral stricture may need to perform intermittent self-catheterization to maintain urethral patency, typically once or twice daily, using a sterile catheter and water-based lubricant, and following proper hygiene practices to prevent infection 1. Antibiotics may be prescribed if there's an associated urinary tract infection, with common choices including trimethoprim-sulfamethoxazole (800/160 mg twice daily) or ciprofloxacin (500 mg twice daily) for 7-14 days.
Justification
Urethral strictures can cause urinary retention, infections, and kidney damage if left untreated, and treatment options such as dilation, urethrotomy, and urethroplasty can help to physically open the narrowed area or reconstruct the urethra to provide a more permanent solution, while self-catheterization helps maintain the urethral opening and prevent re-narrowing 1.
From the Research
Causes of Urethral Stricture
- Straddle injury 2
- Post transurethral surgery 2
- Pelvic fracture 2
- Unknown causes 2
- Excessive per urethral disease 3
Symptoms of Urethral Stricture
- No specific symptoms are mentioned in the provided studies, but it can be inferred that patients may experience difficulty urinating or a weakened urine stream
Factors Affecting Urethral Stricture Treatment
- Length of urethral stricture: longer strictures may have lower success rates with direct vision internal urethrotomy (DVIU) 3, 2
- Excessive per urethral disease: may affect postoperative results 3
- Number of DVIU procedures: repeated procedures may increase the length and number of urethral strictures 4
- Comorbidities: may increase the risk of recurrence 4
- Urinary tract infections (UTIs): may increase the risk of recurrence 4
- Smoking: may increase the risk of recurrence 4