An anterior urethral stricture is a narrowing of the urethra, the tube that carries urine from the bladder out of the body. This specific type of stricture occurs in the front part of the urethra, extending from the bladder neck through the penis. When the urethra narrows, it obstructs urine flow, leading to various urinary difficulties.
Understanding Anterior Urethral Stricture
The anterior urethra includes segments like the bulbar and penile urethra, common sites for stricture formation. These narrowings typically result from scar tissue forming within the delicate urethral lining due to various insults.
Traumatic injuries are a frequent cause, especially “straddle injuries” where the urethra is compressed against the pubic bone, such as falling onto a bicycle crossbar. Pelvic fractures can also damage the urethra, leading to scar tissue. Medical procedures, including prolonged or traumatic catheterization, endoscopic examinations, or prostate surgeries, may also induce urethral trauma that results in strictures.
Infections, such as severe sexually transmitted infections like gonorrhea, can cause inflammation and subsequent scarring. Non-infectious urethritis, an inflammation of the urethra, may also contribute. Over time, these injuries trigger a fibrotic response, where collagen fibers accumulate, constricting the urethral lumen and impeding urine flow.
Recognizing the Signs
Individuals with an anterior urethral stricture often notice changes in their urinary habits. A common symptom is a weak or slow urine stream, which may progressively worsen. Many find themselves straining to urinate, exerting abdominal pressure to force urine out.
The bladder may not feel completely empty after urination, leading to a sensation of incomplete voiding. Other signs include spraying or dribbling of urine after the main stream. Some individuals experience increased frequency of urination during the day or night, along with a sudden, strong urge to urinate.
Recurrent urinary tract infections (UTIs) can also signal an underlying stricture, as stagnant urine provides a breeding ground for bacteria. Other symptoms include pain or discomfort during urination, or the presence of blood in the urine. The specific symptoms and their intensity can vary depending on the stricture’s length, location, and degree of narrowing.
How Anterior Urethral Stricture is Diagnosed
Diagnosis of an anterior urethral stricture begins with a review of the individual’s medical history and a physical examination. The doctor will inquire about urinary symptoms, past injuries, infections, or medical procedures that could contribute to urethral scarring. After this initial assessment, several tests confirm the presence and characteristics of a stricture.
Uroflowmetry is a non-invasive test that measures the speed and strength of the urine stream, showing a reduced peak flow rate in individuals with strictures. This test provides objective data on the degree of urinary obstruction. Another assessment is the post-void residual (PVR) volume measurement, which determines the amount of urine remaining in the bladder after urination; a high PVR can indicate incomplete bladder emptying due to obstruction.
A urethrogram, specifically a retrograde urethrogram (RUG), is performed to visualize the urethra. During this procedure, a contrast dye is injected into the urethra, and X-ray images outline the urethral passage and pinpoint narrowed areas. For direct visualization, a urethroscopy is performed, involving the insertion of a small, flexible scope into the urethra to observe the stricture’s location, length, and severity.
Treatment Options
Treatment for anterior urethral strictures ranges from minimally invasive procedures to complex surgical reconstruction, with the choice depending on the stricture’s length, location, and underlying cause.
Urethral dilation is a less invasive option where specialized instruments, such as balloons or progressively larger dilators, stretch the narrowed segment of the urethra. While this can provide temporary relief, strictures often recur, requiring repeat dilations.
Endoscopic urethrotomy involves inserting a scope into the urethra, through which a small knife or laser cuts the stricture internally. This procedure opens the narrowed passage, but like dilation, it carries a risk of recurrence, with recurrence common.
Urethroplasty is the most definitive surgical treatment, involving the reconstruction or repair of the urethra. One common technique is excision and primary anastomosis, where the diseased segment is removed, and the healthy ends are rejoined. This method is effective for shorter strictures. For longer or more complex strictures, augmentation urethroplasty is performed. This involves using a graft, often tissue from the inner lining of the cheek (buccal mucosa), to enlarge the narrowed urethral lumen. The graft is sewn into place to create a wider, more functional passage for urine flow.
Life After Treatment
Following treatment for an anterior urethral stricture, a period of recovery is expected, varying by procedure. Patients undergoing urethroplasty have a urinary catheter in place for several weeks to allow the reconstructed urethra to heal. Pain management is provided to ensure comfort, and activity restrictions, such as avoiding strenuous exercise or heavy lifting, are advised.
Long-term follow-up care is important due to the possibility of stricture recurrence. Even after successful surgery, there is a small risk that scar tissue may reform. Regular check-ups are scheduled, which include repeat uroflowmetry tests to monitor urine flow rates and detect any signs of re-narrowing early.
Some individuals undergo periodic post-treatment urethroscopy to visualize the healed segment and ensure patency. Successful treatment improves urinary function and quality of life, alleviating symptoms like weak stream, straining, and recurrent infections. Adherence to follow-up schedules helps maintain these positive outcomes.