Urethral strictures
Urethral Strictures: how to recognize and treat them
When we talk about urethral strictures, we refer to the diminution of the urethral lumen which is dedicated to carry urine from the bladder to the urinary meatus. This narrowing can cause difficulties in urination and, in men, can also lead to ejaculatory problems. This condition is quite infrequent: its diagnosis is not always immediate, and its treatment is often quite complex. For this reason, when a urethral stricture is suspected, it becomes essential to consult a specialist in the field who can provide an accurate diagnosis and an appropriate treatment plan.
Although this condition shows an increased incidence after the age of 55 years in both men and women, it is important to know that urethral strictures are not exclusive to older population.
WHAT ABOUT THE CAUSES?
To this question there is not just one answer. There are various causes, and their incidence differs significantly from one country to another.
Among the main causes there are:
– Urinary infections
– Lichen sclerosus: this condition involves the urethra in 20% of cases. Its incidence is certainly higher in uncircumcised men compared to circumcised ones.
– Urethral trauma: this is the second most common cause of urethral strictures in adults; the urethra can be damaged during sport, sexual activity or car accidents.
– Iatrogenic injuries: it is important to remember that any procedure involving the urethra poses a risk factor for the subsequent development of strictures, and therefore, it is recommended to abstain from any unnecessary practice. Currently iatrogenic injuries represent the main cause of urethral strictures in industrialized countries. These may be secondary to catheterization procedures, cystoscopies, surgery for benign prostatic obstruction or surgery for prostate cancer.
– Congenital
– Failed hypospadias repair
– Idiopathic
Regardless of the cause, this condition negatively impacts the patient’s quality of life.
WHEN SHOULD WE SUSPECT A URETHRAL STRICTURE?
The reduction in the caliber of the urethra leads to difficulty urinating. We have two types of symptoms.
1) Some symptoms are closely related to the obstruction of the urethra:
– Weak or intermittent urine stream
– Urinary hesitancy
– Post-voiding dribbling
2) Other symptoms will be due to the damage that urethral stricture causes to the bladder:
– Increased urinary frequency
– Urinary urgency
If not promptly treated, strictures can irreversibly damage the bladder, depriving it of its ability to contract and leading to urinary retention.
HOW TO TREAT THEM?
The first step in treating urethral strictures is recognizing them. An accurate diagnosis cannot overlook a complete medical history aimed to identify the severity and duration of symptoms. A careful physical examination is also essential, along with diagnostic tests such as uroflowmetry, urethroscopy and urethrography. They are indispensable for assessing stricture’s location and extension.
Currently, the main therapeutic options are:
– Endoscopic urethrotomy
– Urethroplasty
Both options have pros and cons: if endoscopic urethrotomy is a quicker procedure, urethroplasty has a higher success rate.
Of course, in the decision-making process, it is crucial to consider the patient’s characteristics and their needs. Once the patient is properly investigated, we can evaluate the best therapeutic choice for him.