What is urethral stricture disease?
A urethral stricture is a scar that forms in the urethra, the tube through which urine leaves the body. As the scar tissue accumulates, it can block or narrow the urethra, making it difficult or painful to urinate. Unless treated, urethral stricture disease might lead to infections and other problems in the urinary tract.
Baylor Scott & White Health focuses on female and male reconstructive urology, including repairing and rebuilding damage caused by urethral strictures. The doctors on our staff have extensive expertise in all areas of female and male urological conditions and surgeries.
Causes of urethral stricture disease
Most urethral scars are related to some sort of trauma, either accidental or surgical. They also can be caused by certain illnesses and treatments for diseases and conditions.
- Straddle injuries. Common in childhood, these injuries happen when someone straddles a hard object such as a bicycle bar, tree limb or fence post. Over time, the scar tissue from the accident can build up enough to narrow or even block the urethra.
- Pelvic fractures. As the pelvis bone shifts with the injury, the urethra can tear. These injuries are usually managed short term by inserting a tube though the abdomen directly into the bladder. The urethra is reconstructed several months later.
- Direct blows. The urethra can be damaged by a kick, punch, tackle, flying baseball, slide, rollover or altercation.
- Surgeries. Operations that can cause urethral strictures are most commonly related to prostate disease in men, vaginal surgeries in women and surgical treatments in men and women.
- Infections. Certain urethral infections such as gonorrhea can cause narrowing of the urethra.
- Inflammatory diseases. Diseases of the urethra and its opening can cause scar tissue and narrowing.
- Radiation treatments. Damage to the urethra caused by radiation treatments are some of the most difficult urethral problems to repair.
Evaluation and diagnosis
There are several techniques used to diagnose urethral stricture disease.
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RUG and VCUG
A retrograde urethrogram (RUG) is usually the first test your doctor will perform. Dye is injected into the urethra using a special syringe, and images are made of the entire urethra from the side. Next, the bladder is filled with dye, and more images of the urethra are recorded as the patient urinates (a voiding cystourethrogram). The two sets of films are compared to get an idea of the exact length and location of the narrowing.
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Cystoscopy
A tiny camera is passed down a tube into the bladder to allow doctors to assess the depth of the scar, the scar’s length and the general appearance of the urethra, including any other scars. This procedure is sometimes performed with an RUG or VCUG.
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Duplex Doppler ultrasound
In cases that involve damage to blood vessels, doctors will perform a blood flow test to assess these injuries before repairing the urethra. reconstruction. This technique uses a special Doppler ultrasound device to assess the blood flow into and out of the affected area.
Urethral stricture disease treatment options
There are both minimally invasive and open surgical treatment for urethral strictures.
Urethral strictures usually are first treated with an endoscopic procedure. In this minimally invasive treatment, a tiny scope is inserted into the urethra. The stricture is cut using a knife or laser attached to the scope.
Another minimally invasive technique is to pass a wire through the stricture using a flexible, then make the stricture wider by passing dilators along the wire to stretch the scar tissue.
The most effective open surgical treatment for urethral stricture disease with the best long-term results is a procedure called excision with primary anastomosis procedure (EPA). This technique involves removing the scarred section of the urethra, then stitching the urethra back together. If a large section of the urethra is removed, skin grafts are used to repair and reconnect the urethra.