What is a Urethral Stricture?
A urethral stricture is an abnormal narrowing of the urethra caused by fibrotic scarring of the urethral mucosa and underlying corpus spongiosum (spongiofibrosis), leading to urinary obstruction. 1
Definition and Pathophysiology
The term "urethral stricture" is the preferred terminology for any abnormal narrowing of the anterior urethra 1. This narrowing results from inflammatory or traumatic processes that cause spongiofibrosis—the formation of scar tissue that progressively constricts the urethral lumen 2.
Common Causes
In Men:
The etiology varies, with many cases being idiopathic. However, identifiable risk factors include 1:
- Iatrogenic causes (most common in industrialized countries):
- Transurethral surgery (most common iatrogenic cause)
- Urethral catheterization or instrumentation
- Prostate cancer treatment
- Traumatic injury to the urethra
- Hypospadias surgery history
- Lichen sclerosus (tends to produce longer strictures, commonly in penile urethra, with higher association with urethral cancer)
In Women:
Urethral strictures are most commonly iatrogenic, typically following 1:
- Painful or traumatic catheterization
- Multiple urethral dilations (leading to fibrosis from bleeding and extravasation)
- Blunt pelvic trauma
- Obstetric complications (particularly cephalopelvic disproportion)
- Malignancy or radiation
- Urethral/vaginal atrophy
- Recurrent infections
- Skin diseases (lichen planus, lichen sclerosus)
Clinical Presentation
Clinicians should include urethral stricture in the differential diagnosis for patients presenting with: 1
- Decreased urinary stream (weak stream)
- Incomplete bladder emptying
- Urine spraying
- Dysuria
- Recurrent urinary tract infections
- Rising post-void residual volumes
- Urinary retention (in severe cases)
Sexual dysfunction occurs in only a small minority of men with urethral stricture 1.
Impact on Health
Urethral strictures significantly impact both health and quality of life 3. If left untreated, they cause obstructive voiding dysfunction and can lead to long-term damage of the entire urinary tract, including potential renal impairment 2, 4. The condition predominantly affects men and carries substantial morbidity through chronic urinary obstruction 2.