Scar tissue can make the urethra smaller, and it can be caused by: 

• A procedure that involves putting something into the urethra, like an endoscope;
• Inserting a catheter to drain the bladder; 
• When the urethra or pelvis is injured;
• An enlarged prostate or a history of surgery to remove or shrink an enlarged prostate;
• Urethral or prostate cancer;
• Sexually transmitted infections (STI);
• Treatments using x-rays.

Experts estimate that 229-627 males out of every 100,000 will develop a urethral stricture.

Reduced urine output is the most noticeable symptom of urethral stricture. Some of the signs of this condition are:

• Having to force urine out
• Urethral discomfort
• Contagious infection of the urinary tract
• Prostatitis

In extreme cases, patients with urethral strictures can lose the ability to urinate completely. Urinary retention is a life-threatening condition. The accumulation of urine in the kidneys due to ineffective bladder drainage can also cause hydronephrosis and, ultimately, renal failure.

Inflammation of the prostate may also result from a urethral stricture. The prostate is located beneath the bladder and completely encircles the urethra.

Uroflowmetry is the first test that doctors do. It gives a good idea of the flow of urine through the urethra. In triphasic uroflowmetry, doctors can distinguish if a patient has a functioning urethra, obstruction due to benign prostatic, or urethral stricture.

Urethroscopy or cystoscopy is a quick and easy way to check for urethral stricture and can specifically identify where the stricture is located.

If the symptoms and uroflowmetry test show signs of a stricture, the next test is urethrography to confirm the diagnosis. Further, retrograde urethrography (RUG) can show the entire urethra all the way to the bladder.

Ultrasonography (US) is mostly used to check the bladder and upper urinary tract. It can show a thickening of the wall of the urinary bladder. Ultrasound can also show the volume of unvoided urine after urination, which can help the doctor figure out how much the strictured urethra has blocked. 

Treatment

The results of the imaging tests will help decide how to treat urethral stricture. Some options for treatment are: 

• widening of the urethra; 
• urethrotomy from the inside; 
• reconstruction of the urethra.

Initially, a short stricture may be treated with urethral dilation or an internal urethrotomy. Doctors then widen the urethra using a cystoscope and a series of dilating tools that become progressively larger while the patient is under general anesthesia. 

If dilation or urethrotomy does not work and the stricture returns, urethral reconstruction may be needed to open the urethra.

Avoid any activities that can injure the pelvic area.  

For older men, consult a physician for a urethral or prostate cancer screening so that steps can be done when there are risks. 

Lastly, use protection when unsure about sexual partners’ prophylactic status. 

References

Abdeen BM, Badreldin AM. Urethral Strictures. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564297/

Cleveland Clinic (2022). Urethral Stricture in Men. Retrieved December 22, 2022, from https://my.clevelandclinic.org/health/diseases/15537-urethral-stricture-in-men

National Health Services (2022). Urethral Stricture. Retrieved December 22, 2022, from https://www.mayoclinic.org/diseases-conditions/urethral-stricture/symptoms-causes/syc-