The aim of the leaflet is to provide you with detailed information about what causes urethral stricture disease and how it is treated.

Where is the urethra and what does it do?

In men, the urethra is a tube that carries urine from the bladder, and semen from the ejaculatory ducts, out of the body. From the bladder, it goes through your prostate, your external sphincter (muscle that helps you remain continent), your perineum (the area between scrotum and anus) and your penis.

What is a Urethral Stricture?

A urethral stricture is a narrowing caused by scarring of the lining of the urethra and the surrounding corpus spongiosum. Strictures can range from less than 1cm long to those that extend the entire length of the urethra. They can occur at any point along the urethra, but are most often seen in the bulbar region.

What are the causes of Urethral Strictures?

 The most likely cause depends on the site of the stricture. Broadly, the commonest reasons are:

• Idiopathic- Cause unknown
• Inflammatory- Caused by infection or inflammation in the urethra, e.g. STIs, lichen sclerosus (LS) also known as BXO.
• Traumatic- Caused by injury, e.g. a fall astride or crushing pelvic trauma.
• Iatrogenic- Caused by medical intervention, e.g. repeated procedures, catheterisation, radiotherapy or surgery.
• Congenital- Inherited conditions e.g. hypospadias.

What symptoms might I have with a urethral stricture?

Poor urinary flow; spraying or splitting of the stream; dribbling after urination; urinary frequency; infections; reduced force of ejaculation; and pain on passing urine.

What are the risks if I leave stricture untreated?

It can act as a “bottleneck” preventing bladder emptying. This can result in bladder, prostate or kidney infections, and lead to the formation of stones, causing long-term damage and kidney failure.

How is a stricture diagnosed?

Suspected if you have a reduced flow rate or incomplete emptying on ultrasound. Diagnosed by examination, uroflowmetry, RGU-MCU (urethrogram), failure to pass a catheter/telescope, ultrasound, or MRI scan.

What treatments are available for my stricture?

• Urethral dilatation: Passing a plastic or metal dilator to stretch the area. There is a high risk the stricture will return.
• Optical Internal Urethrotomy (OIU): Passing a telescope to cut the stricture. Almost 50% risk of recurrence for first-time procedures.
• Open urethroplasty: Higher success rate. Includes Anastomotic (cutting out the narrowed area) or Augmentation buccal mucosa graft (using cheek lining to widen the area).
• Two-stage penile urethroplasty: Used for penile urethral strictures, involving two operations several months apart.
• Perineal urethrostomy: Bringing the urethra out to the skin surface in the perineum. You will need to sit down to pass urine.
• Catheters: Long-term urethral or suprapubic catheters for those avoiding complex treatment.

Most patients have a good outcome. Quick treatment is the best way to avoid serious complications. All mentioned procedures are regularly performed by experienced urologists with excellent results.