Urethral stricture is a condition characterized by a narrowing of the urethra, the tube that carries urine from the bladder out of the body. While more commonly discussed in males, it can occur in females and affect urinary function. Female urethral stricture can lead to various uncomfortable symptoms and, if left unaddressed, may cause complications.
Understanding Female Urethral Stricture
Female urethral stricture is a narrowing of the urethra, typically caused by scar tissue. The female urethra is a short tube, approximately 1.5 inches (3 to 4 cm) long, extending from the bladder to an opening in front of the vagina.
When scar tissue develops, it can impede urine flow, creating a blockage. While less common in females than males, urethral strictures are a cause of bladder outlet obstruction in women, accounting for approximately 4-13% of cases.
Recognizing the Symptoms
Females with a urethral stricture experience various urinary symptoms. A common indicator is a weak or slow urine stream, often requiring straining to initiate or maintain urination. The stream may also spray or split.
Patients may report incomplete bladder emptying, leading to a frequent urge to urinate. Increased urinary frequency and urgency, as well as pain or burning during urination (dysuria), are also common. Recurrent urinary tract infections (UTIs) are a frequent consequence, as stagnant urine creates an environment for bacterial growth. Some individuals may experience urethral pain or acute urinary retention.
Common Causes
Female urethral strictures can arise from several factors that lead to scarring. Trauma to the urethra is one category. This can occur from internal sources, such as complications from urological procedures or catheterization, or from external injuries like those sustained during childbirth or pelvic surgery.
Inflammation is another contributing factor. Chronic infections, such as recurrent urinary tract infections, can cause persistent irritation and scar tissue formation within the urethral lining. Certain medical conditions, like lichen sclerosus, an inflammatory skin condition, can also lead to scarring and narrowing, particularly at the urethral opening. Radiation therapy for pelvic cancers can also induce urethral stricture. While a specific cause is not always identifiable, these factors are common origins.
Diagnosis and Treatment Approaches
Diagnosing female urethral stricture typically involves a comprehensive evaluation by a healthcare provider. The process often begins with a physical examination and a review of the patient’s urinary symptoms. Urinalysis and urine culture are usually performed to check for any underlying infections.
Uroflowmetry, a test where the patient urinates into a special device that measures the speed and volume of urine flow, can reveal a slow or protracted flow rate, which is indicative of a stricture. A post-void residual (PVR) volume measurement, often done with an ultrasound, assesses how much urine remains in the bladder after emptying, with a higher volume suggesting incomplete emptying. Imaging studies, such as a voiding cystourethrogram (VCUG) or an antegrade urethrogram, involve using contrast dye and X-rays to visualize the urethra and bladder, helping to pinpoint the location and extent of the narrowing. Cystoscopy, where a small, flexible camera is inserted into the urethra and bladder, allows direct visualization of the stricture and surrounding tissue.
Treatment approaches for female urethral stricture vary depending on the stricture’s characteristics and the patient’s individual needs. Urethral dilation is a common initial approach, involving the gentle stretching of the narrowed urethra using progressively larger dilators. While it can provide temporary relief, the success rate for sustained improvement is not high, with some studies reporting success rates around 47% at 43 months, and lower rates if previous dilations have occurred. Some patients may benefit from regular, planned self-dilation at home.
Endoscopic incision, also known as urethrotomy, involves using a thin, scope-guided tool to cut the stricture. This procedure aims to widen the narrowed area, and while it offers a faster recovery than open surgery, the stricture can recur.
For more complex or recurrent strictures, open surgical repair, known as urethroplasty, is often considered the most definitive treatment. This procedure involves surgically removing the scarred section of the urethra and reconstructing it. Depending on the stricture’s length and location, healthy tissue, such as a graft from the lining of the mouth (buccal mucosa) or a flap of vaginal or labial skin, may be used to create a wider, more functional urethra. After urethroplasty, a urinary catheter is typically left in place for one to three weeks to allow the repaired area to heal. It is advisable for individuals with urethral stricture symptoms to consult with a urologist to discuss the most appropriate treatment options for their specific situation.