Urethral Stricture
Urethral stricture refers to a narrowing of the urethra caused by fibrosis and scarring of the urethral mucosa and surrounding spongy tissue, known as “spongiofibrosis.”
This narrowing can obstruct the normal flow of urine from the bladder to the outside. In men, strictures most commonly affect the bulbar urethra. In women, although less frequent, they can also occur and are defined as a fixed anatomical narrowing that reduces the urethral caliber.
Symptoms
The most common symptoms of penile cancer include:
- Lower urinary tract symptoms (LUTS): difficulty initiating urination, weak or intermittent urinary stream, sensation of incomplete bladder emptying, and increased urinary frequency.
- Acute urinary retention: sudden inability to urinate, requiring immediate urological attention.
- Urinary tract infections (UTIs): increased susceptibility to infection due to obstructed urinary flow.
- Genitourinary pain: pain in the bladder or urethral area, sometimes associated with more severe symptoms.
- Visible hematuria: presence of blood in the urine.
It is important to note that some patients may be asymptomatic or present only mild symptoms, while others may experience severe symptoms significantly affecting quality of life.
Diagnosis
The diagnosis of urethral stricture involves a comprehensive evaluation that includes:
- Detailed medical history: assessment of symptoms, duration, severity, and history of trauma, prior surgeries, urethral instrumentation, or infections.
- Physical examination: includes palpation of the abdomen and perineum, and in men, a digital rectal examination to assess the prostate and urethra.
- Urinalysis and urine culture: to detect urinary infections or hematuria.
- Uroflowmetry and post-void residual measurement: to assess urinary flow and determine the amount of urine remaining in the bladder after voiding.
- Imaging studies: retrograde and voiding urethrography to visualize the urethral anatomy, localize the stricture, and determine its length and severity.
- Urethroscopy (endoscopic evaluation): allows direct visualization of the stricture and assessment of its extent and severity.
These tests help determine the location, length, and severity of the stricture, which are crucial for planning appropriate treatment.
Treatment
The management of urethral stricture depends on several factors, including the location, length, and severity of the stricture, as well as the patient’s overall health and preferences. Treatment options include:
- Urethral dilation: procedure using dilator sounds or balloon catheters to widen the narrowed urethra. This is a temporary solution and may require frequent repetition.
- Optilume: a system combining mechanical dilation with a drug-coated balloon (paclitaxel), which prevents recurrence of the stricture by reducing scar tissue proliferation. Unlike conventional treatments, Optilume reduces recurrence rates and avoids repetitive procedures
- Internal urethrotomy: an endoscopic procedure involving incision of the stricture to widen the urethral lumen. Success rates vary, and it may be necessary to repeat procedures.
- Urethroplasty with or without oral mucosa graft: open surgery involving reconstruction of the affected urethra. This is the definitive treatment for many strictures and has higher success rates than other methods.
Treatment choice should be individualized, considering the specific characteristics of the stricture and the patient’s circumstances.
Prevention
Prevention of urethral stricture focuses on minimizing known risk factors, which include:
- Avoiding urethral trauma: limiting the use of urethral catheters and unnecessary instrumentation.
- Adequate treatment of urethral infections: to prevent inflammation and scarring that can lead to stricture.
- Careful management of pelvic or perineal injuries: to reduce the risk of urethral damage.
Although not all strictures can be prevented, reducing these risk factors can lower the incidence of the condition.
