Bulbar Strictures
One of the most common sites for urethral strictures is the bulbar urethra, located under the scrotum in the perineum. This area is poorly protected, making it more vulnerable to injury. Unlike the lungs (shielded by the ribs) or the brain (protected by the skull), the bulbar urethra lacks an external barrier to prevent damage.
Causes
Straddle Injury
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The bulbar urethra is particularly vulnerable to straddle trauma, such as from sports, bicycles, skateboards, or impact injuries. This trauma can crush the urethra against surrounding bone, leading to immediate swelling or blood at the urethral opening. In many cases, however, a bulbar urethral stricture develops gradually as scar tissue forms during the healing process. Some patients may not even recall the injury that caused the stricture. These strictures are typically short in length and, if treated properly, are highly curable.
Treatment
For bulbar strictures less than 1.5-2 cm in length, treatment options include dilation, direct vision internal urethrotomy, or open urethral reconstruction. Unfortunately, many men are treated with dilation or urethrotomy without prior imaging and often undergo repeated ineffective treatments, unaware that open repair is the only curative option. The preferred technique for shorter strictures is excision and primary anastomosis, where the narrowed segment is removed and the healthy ends are reconnected with sutures. This procedure is highly successful.
For bulbar urethral strictures longer than 1.5-2 cm or recurrent strictures, internal urethrotomy offers only temporary relief with a low success rate. The preferred treatment for longer strictures is open urethral reconstruction (urethroplasty). When the stricture is too long for excision and primary anastomosis, anastomotic urethroplasty is used. In these cases, removing too much of the urethra creates a gap too large to reconnect without tension.