Urethral stricture surgery

What is understood by a urethral stricture?

A urethral stricture is a scarred narrowing of the urethra. The longitudinal extent and the position of the stricture can vary greatly. Strictures differ in terms of position between frontal (penile / bulbar) and rear (membranous) and in terms of length between short-path and long-path.

What complaints are caused by a stricture of the urethra?

A urethral stricture can trigger problems with the urination process. The result is so-called obstructive micturation symptoms, such as a weak urine flow, incomplete emptying of the bladder and residual urine or, in severe cases, urine retention. Patients describe irritative symptoms such as frequent urination with only small amounts of urine (pollakisuria), the need to apply pressure when urinating, and getting up at night to go to the toilet (nocturia). There is also a frequent incidence of urinary tract infections accompanied by inflammation of the prostate (prostatitis) and epididymis (epididymitis).

What are the causes of a urethral stricture?

There are several ways in which a urethral stricture can be triggered. In frequent cases, injury of the urethra can be followed a healing process accompanied by scarring. Trauma in the area of the perineum, e.g. from a bicycle fall, frequently leads to a bulbar urethral stricture resulting from compression. Strictures in the area of the penile urethra are often caused by direct injury of the urethra as a result of manipulations, such as catheterisation. Rearward urethral injuries frequently occur in the context of injuries to the bony pelvis.

Besides accident related causes (trauma) past inflammations of the urethra (urethritis), in particular gonorrhoea, can lead to a stricture. Chronic inflammations under the foreskin (balanitis) and narrowing of the foreskin (phimosis) may also be responsible for a stricture of the urethral orifice and the frontal (penile) urethra. With the long-term application of a urethral catheter, the urethra may become damaged by excessive pressure, leading to the formation of a stricture. Operational procedures conducted through the urethra in the case of benign prostate enlargement, such as transurethral electroresection of the prostate (TUR-P) and laser enucleation of the prostate (HoLEP) can in rare cases lead to a stricture of the urethra or bladder opening. This complication can be reduced to a minimum with adequate antibiotic prophylaxis and the shortest possible catheter dwell time. Another rare occurrence are strictures on the juncture between the urethra and the bladder and the total removal of the prostate (anastomotic stricture) in the course of a prostate cancer operation (radical prostatectomy).

Congenital urethral stricture can be neglected as a cause due to the rareness of its occurrence in every day clinic experience.