Urethral Strictures
Normal
Causes
Straddle Injury
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A straddle trauma injury, often caused by straddling a hard object, can damage the urethra and lead to a stricture, typically in the bulbar urethra. Although symptoms may not appear for months or even years, they can include bleeding and difficulty urinating. While some patients do not recall a specific injury, bulbar strictures are rarely seen without prior trauma, suggesting a forgotten injury as the likely cause.
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Pelvic Bone Fracture Posterior Urethral Disruptions
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A pelvic bone fracture is a serious injury that can have long-lasting effects. Common causes include motor vehicle accidents and crushing injuries, often in work-related settings. In some cases, the fracture is accompanied by a tear in the membranous portion of the posterior urethra, causing the ends to separate and resulting in the loss of the ability to urinate.
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Lichen Sclerosus = Balanitis Xerotica Oblitarans
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Lichen sclerosus, also known as balanitis xerotica obliterans, is a debilitating disease with an unclear cause. Its primary symptom is whitish discoloration of the penile skin, which can lead to urethral strictures. These strictures often affect the meatus (urethral opening at the tip of the penis) or, in some cases, extend further along the urethra.
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Hypospadias Surgery
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Hypospadias is a condition where a boy is born with an undeveloped urethra, causing the opening to be on the underside of the penis instead of the tip. Treatment typically involves surgery to reposition the urethra to the tip. However, urethral strictures can sometimes develop as a complication of the surgery.
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Urologic Procedures
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During urologic treatments, catheters or instruments are often inserted through the urethra into the bladder, which can sometimes cause damage and lead to stricture formation. The fossa navicularis, near the urethral opening at the tip of the penis, is the most commonly affected area. Additionally, prostate surgery or radiation can result in complex strictures involving the bladder neck and/or membranous urethra.
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Other Causes
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The common causes of urethral strictures include trauma, surgery, and medical procedures. Rare causes can include the insertion of foreign objects into the urethra or surgeries like penile implant procedures. While some sources mention urinary tract infections, such as gonorrhea, as a cause, this is extremely rare and typically only occurs in severe cases.
Symptoms
The most common symptoms of a urethral stricture are reduced urine flow and increased time to empty the bladder. This can be compared to a kink in a garden hose, where a small blockage can significantly reduce water flow, even if it is only a small part of the hose.
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When Do Symptoms Present Themselves?
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Urethral stricture symptoms can develop gradually or appear suddenly. Some patients may not realize there is a problem, as they are accustomed to a slow urine flow. However, they often notice that their urination sound and duration differ from others when standing at a urinal.
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Urethral Stricture Symptoms Lead to More Serious Problems
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If slow urine flow were the only issue, most patients might choose to live with a stricture. However, the obstruction caused by urethral strictures can lead to more serious complications.
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Urethral obstruction forces the bladder to work harder, causing it to thicken over time, which damages its structure. The smooth interior of the bladder becomes irregular, with a strand-like appearance visible during visualization, and imaging shows significant bladder wall irregularity. This condition is known as trabeculation.
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In some cases, the increased pressure from urethral obstruction can cause the bladder’s inner lining to herniate through the bladder muscle, forming one or more outpouchings known as bladder diverticula. These diverticula are not surrounded by muscle and may not empty during urination, increasing the risk of infections.