Rigi10™ Malleable Penile Prosthesis
Also Known As
Urethral stenosis, Urethral narrowing, Stricture of urethra, Urethral coarctation.
Definition
Urethral stricture is an abnormal narrowing of the urethra, the tube that carries urine out of the body. This narrowing is typically caused by scar tissue (fibrosis) that forms following inflammation or injury to the urethral lining (mucosa) and surrounding tissues. The scar tissue can build up and contract, leading to a reduction in the urethral lumen’s diameter, which obstructs the normal flow of urine.1 The pathophysiology involves an initial injury or inflammation leading to urine leakage into the corpus spongiosum (the spongy tissue surrounding the male urethra). This triggers an inflammatory response and subsequent fibrotic changes. Over time, this fibrous tissue matures, shrinks, and causes the urethral lumen to narrow. This process can become a vicious cycle, where the stricture itself makes the urethra more susceptible to further trauma and inflammation, leading to progressive worsening of the narrowing.1 The primary purpose of identifying and understanding urethral stricture is to enable timely diagnosis and appropriate management to alleviate symptoms, prevent complications such as urinary retention, recurrent urinary tract infections (UTIs), bladder stones, and kidney damage, and improve the patient’s quality of life.2,4
Clinical Context
Urethral stricture is clinically suspected in patients, predominantly males, presenting with lower urinary tract symptoms (LUTS). These symptoms often develop gradually and include a weak or spraying urinary stream, straining to urinate, a feeling of incomplete bladder emptying, post-void dribbling, urinary intermittency, increased urinary frequency, urgency, and nocturia.1 Recurrent urinary tract infections and unexplained dysuria (painful urination) are also common presentations.4 Patient selection for investigation typically involves those with persistent LUTS, especially if they do not respond to medical therapy for other conditions like benign prostatic hyperplasia (BPH), or if they have a history of urethral trauma (e.g., pelvic fracture, straddle injury), prior urethral instrumentation (e.g., catheterization, cystoscopy, transurethral surgery), or infections like gonorrhea or lichen sclerosus.3
Diagnostic evaluation usually starts with uroflowmetry to measure urine flow rate, followed by imaging studies such as retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to visualize the location, length, and severity of the stricture. Cystoscopy allows direct visualization of the stricture.1
Treatment strategies vary based on the stricture’s characteristics (length, location, severity, etiology) and patient factors. Options range from minimally invasive endoscopic procedures to open surgical reconstruction. Endoscopic treatments include urethral dilation (stretching the stricture) and direct vision internal urethrotomy (DVIU), which involves cutting the scar tissue. These are often suitable for shorter, less complex strictures but have higher recurrence rates.2,4 For longer, more complex, or recurrent strictures, urethroplasty is the gold standard treatment. Urethroplasty involves surgically removing the scarred segment and rejoining the healthy urethral ends (anastomotic urethroplasty) or augmenting the narrowed segment with tissue grafts (e.g., buccal mucosa) or flaps (substitution urethroplasty).2 Expected outcomes aim to restore normal urine flow, relieve symptoms, and prevent recurrence and complications. While endoscopic treatments may offer immediate relief, urethroplasty generally provides better long-term success rates.4