What is urethral stricture disease?

A urethral stricture is a scar that forms in the urethra, the tube through which urine leaves the body. As the scar tissue accumulates, it can block or narrow the urethra, making it difficult or painful to urinate. Unless treated, urethral stricture disease might lead to infections and other problems in the urinary tract.

Baylor Scott & White Health focuses on female and male reconstructive urology, including repairing and rebuilding damage caused by urethral strictures. The doctors on our staff have extensive expertise in all areas of female and male urological conditions and surgeries.

Causes of urethral stricture disease

Most urethral scars are related to some sort of trauma, either accidental or surgical. They also can be caused by certain illnesses and treatments for diseases and conditions.

  • Straddle injuries. Common in childhood, these injuries happen when someone straddles a hard object such as a bicycle bar, tree limb or fence post. Over time, the scar tissue from the accident can build up enough to narrow or even block the urethra.
  • Pelvic fractures. As the pelvis bone shifts with the injury, the urethra can tear. These injuries are usually managed short term by inserting a tube though the abdomen directly into the bladder. The urethra is reconstructed several months later.
  • Direct blows. The urethra can be damaged by a kick, punch, tackle, flying baseball, slide, rollover or altercation.
  • Surgeries. Operations that can cause urethral strictures are most commonly related to prostate disease in men, vaginal surgeries in women and surgical treatments in men and women.
  • Infections. Certain urethral infections such as gonorrhea can cause narrowing of the urethra.
  • Inflammatory diseases. Diseases of the urethra and its opening can cause scar tissue and narrowing.
  • Radiation treatments. Damage to the urethra caused by radiation treatments are some of the most difficult urethral problems to repair.

Evaluation and diagnosis

There are several techniques used to diagnose urethral stricture disease.

Urethral stricture disease treatment options

There are both minimally invasive and open surgical treatment for urethral strictures.

Urethral strictures usually are first treated with an endoscopic procedure. In this minimally invasive treatment, a tiny scope is inserted into the urethra. The stricture is cut using a knife or laser attached to the scope.

Another minimally invasive technique is to pass a wire through the stricture using a flexible, then make the stricture wider by passing dilators along the wire to stretch the scar tissue. The stricture may also be dilated with a balloon that places medication in the scar tissue to reduce the risk of recurrence.

The most effective open surgical treatment for urethral stricture disease with the best long-term results is a procedure called excision with primary anastomosis procedure (EPA). This technique involves removing the scarred section of the urethra, then stitching the urethra back together. If a large section of the urethra is removed, grafts are used to repair and reconnect the urethra.