Urethral Stricture

What is a urethral stricture?

A urethral stricture is scar tissue with the urethra, which is the small tube that carries urine from the bladder to the outside. Normally the flow of urine through the urethra is free and easy, however when scar tissue forms it can cause a blockage that results in a slow urinary flow, or difficulty or inability to urinate. That blockage can occur anywhere from the bladder to the opening of the urethra into the vagina. Urethral strictures are relatively rare in women, but can be highly symptomatic. Fortunately, there are good treatment options.

Causes

There are several causes of urethral strictures:

• Trauma to the urethra. This can either be external trauma usually from hitting the urethra hard against the pubic bone, or by internal trauma usually after a urological procedure or catheterization.
• Inflammatory disease. There are a number of diseases that can cause severe inflammation of the urethra causing a breakdown and subsequent scarring of normal tissue.
• Estrogen deficiency. Sometimes a lack of estrogen can cause a narrowing at the opening of the urethra (urethral meatus)
• Radiation used to treat certain gynecological, urological or gastrointestinal tumors
• Idiopathic where the cause is not obvious

Symptoms

The symptoms of a urethral stricture are usually related to problems emptying the bladder. These include a slow or interrupted urinary stream, incomplete bladder emptying or inability to urinate. Sometimes these can be associated with urinary frequency, urgency, or urgency incontinence.

Diagnosis

There are several ways to diagnose a urethral stricture. In some cases your doctor may have you urinate into a special toilet that can measure the flow of urine to determine if the stream is slow. If the flow rate is abnormally slow, this may raise the suspicion that a stricture is present. Also your doctor may try to pass a small catheter through the urethra into the bladder. If resistance is met or the catheter can not be advanced into the bladder a stricture may be present. A cystoscopy, where a small scope is placed through the urethra into the bladder to look for scarring and narrowing of the urethra, may be done. Lastly imaging studies X-Ray or ultrasound may be used to aid in diagnosis.

Treatment

The simplest treatment for a symptomatic urethral stricture is a urethral dilation. Here the urethra is "stretched" and the scar tissue is broken so that the urethra can heal with a wider caliber. This is usually done with a metal tube or sound. Unfortunately, three-quarters of strictures will recur after dilation and dilation often needs to be repeated. Depending on the frequency of dilations, this may not be a good option for some women Some women will opt to pass a small catheter daily to keep the scar tissue open. There are also surgical options available to remove or bypass the scar tissue. These can be done in a variety of different ways depending on the length and location of the stricture. These reconstructive procedures are highly effective in curing the symptoms related to urethral strictures.

Drug-coated balloon dilation (Optilume) is a new minimally invasive treatment option done under local or light anesthesia and typically used to treat short strictures. A urologist will use the Optilume drug-coated balloon to simultaneously dilate the stricture and coat the stricture area with a drug that is designed to prevent formation of scar tissue.