Urethral stenosis refers to the narrowing of the urethra (the tube that carries urine from the bladder to the outside of the body). This narrowing restricts the normal flow of urine and can lead to a range of urinary symptoms and complications if left untreated. The condition is more common in men than women and can develop as a result of inflammation, trauma, surgery, or prior catheterization.
Causes of Urethral Stenosis
- Injury or Trauma: Accidents involving the pelvis or perineum, including falls or blunt force injuries, can damage the urethra.
- Medical Procedures: Prior surgeries, prolonged catheter use, or instrumentation of the urethra can lead to scarring and narrowing.
- Infections: Certain sexually transmitted infections (such as gonorrhea) or chronic urinary tract infections can cause urethral inflammation and scarring.
- Radiation Therapy: Pelvic radiation, particularly for prostate or bladder cancer, may result in long-term urethral changes.
- Inflammatory Conditions: Chronic inflammatory disorders such as lichen sclerosus can affect urethral tissue.
Symptoms
- Weak or slow urinary stream
- Straining to urinate
- Incomplete bladder emptying
- Frequent urination or urgency
- Urinary tract infections
- Dribbling or spraying of urine
- Blood in the urine (hematuria)
Diagnosis
Evaluation typically begins with a physical exam and patient history, followed by tests such as:
- Urinalysis: To check for signs of infection or blood.
- Post-void residual test: To assess urine retention.
- Uroflowmetry: Measures the speed and volume of urine flow.
- Cystoscopy: Direct visualization of the urethra using a thin camera.
- Retrograde urethrogram: X-ray imaging using contrast dye to evaluate the location and length of the stricture.
Treatment Options
Treatment is based on the severity and location of the stenosis:
- Urethral Dilation: Gradual stretching of the narrowed area. May offer temporary relief but often requires repeat procedures.
- Direct Vision Internal Urethrotomy (DVIU): A minimally invasive procedure to cut and open the narrowed segment using a small scope.
- Urethral Reconstruction (Urethroplasty): Surgical repair that involves removing the narrowed segment or reconstructing the urethra using graft tissue. Considered the gold standard for long-term success.
- Stent Placement: In select cases, a permanent stent may be used to keep the urethra open.
When to See a Urologist
If you are experiencing difficulty urinating, recurrent UTIs, or a weak urinary stream, it’s important to consult a urologist. Early diagnosis and intervention can prevent complications such as bladder damage, infections, and kidney issues.