The urethra is part of the urinary system, wherein urine flows from the bladder, and for men, it is also a passageway for semen. Men have longer urethra compared to women. The urethra is controlled by urethral sphincters. The internal urethral sphincters are involuntary muscles surrounding the bladder neck to the urethra. The external urethral sphincters are voluntary muscles located distally and inferiorly to the bladder neck, where a person can control when to relax to allow urine to pass through the urethra.
When an obstruction is present anywhere in the urethra, it causes to narrow urethra resulting in urethral stricture. The scar formation is caused by untreated or recurrent infections, injury to the urethra, previous surgery, and catheters or instruments inserted through the urethra.
Some of the main factors causing urethral stricture to include:
- Injury: any trauma affecting the penis or scrotum or a straddle injury, fracture of the pelvic bones
- Infections: infections affecting the urethra are sexually transmitted infections such as chlamydia, gonorrhea, or urethritis, recurrent urinary tract infections
- Previous surgery involving urethra or prostate: such as hypospadias surgery, radical prostatectomy, transurethral resection of the prostate (TURP)
- Catheters or instruments passing the urethra: insertion of foley catheters, instruments used in cystoscopy
- A congenital defect on the urethra- happens
There’s a high occurrence rate of urethral stricture in males compared to females. Urologists classify urethral strictures in males through the place of occurrence:
- Posterior urethral stricture: the urethral stricture occurs anywhere from the bladder neck down to the portion where surrounded by the prostate, it is about 1-2 inches in length.
- Anterior urethral stricture: narrow urethra can occur anywhere below the posterior urethra down to the urethral meatus, it is about 9-10 inches in length.
Signs and symptoms
Urethral stricture symptoms include:
- Recurrent urinary tract infections
- A slow flow of urine
- Frequent urination
- Urinary incontinence (inability to control urination)
- Pain upon urination or pain on the lower abdominal area
- Straining to pass out urine
- Feeling that bladder is not fully emptied
- Blood in the urine (hematuria)
If the urethral stricture has totally caused the closure of the tube, a person cannot urinate and will lead to urinary retention. This is dangerous as it can lead more problems involving the kidneys or the entire urinary system.
Urethral stricture in males could affect the prostate because it is surrounding the urethra, leading to prostatitis. Urethral stricture treatment should be given promptly, to avoid further complications and damage.
Risk Factors and complications
Risk factors that can lead to the development of urethral stricture:
- Men who experienced one or more sexually transmitted infection
- Recent experience of trauma or injury in the pelvic area
- Who just had foley catheter/ catheter inserted through the urethra to drain urine
- Had just experienced infections affecting the urethra such as urethritis and urinary tract infection
- Men who have prostate enlargement
- Recent surgery in the urethra or prostate
After urethral stricture treatment, complications can arise such as:
- Recurrence of urethral stricture
- Urinary incontinence- the inability to hold or control urination.
There’s a high success rate of surgical urethral reconstruction. Here is some information you need to note after the urethral stricture surgery:
- After discharge, an indwelling catheter will be placed and attached to a urine collection bag for about 10 to 20 days to allow the urethra to heal.
- Sexual intercourse can be resumed once the indwelling catheter has been removed by your doctor or depending on your doctor’s advice.
- You can resume work in about 2 weeks if you have office jobs or jobs that do not require much physical activity.
- For work that requires physical strength or strenuous activities can be resumed for after 4 weeks at least.
- Showers can be taken 2-3 days after surgery.
- Take prescribed pain medications to alleviate pain, swelling and discomfort.
- Contact your urologist if you have fever, blood or pus draining on the post-operative site, increasing pain and cannot be alleviated with prescribed medications, swelling, redness or tenderness in the post-operative site.
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