Constrictions of the urethra

Strictures of the urethra have been a serious problem for centuries. By obstructing the free flow of urine, they can eventually result in kidney failure.

The urethra, a soft, flexible, stretchable, expandable urinary conduit, is normally empty and collapsed. It expands to its full size by the presence and the force of urine flowing through it. A stricture of the urethra is an abnormal constriction of a portion too tight to permit expansion by the force of the passing urinary stream. This unexpandable narrowing can interfere, just as an enlarged prostate can interfere, with the free flow of urine. The symptoms of both conditions are similar and include a slow stream, intermittency, incomplete emptying, frequency, urgency and sleep interruption.

A stricture is a scar and like all scars, heals by contraction. Since the scar is present around the entire circumference of the urethra, its contraction narrows the urinary passageway. A urethral stricture can be caused by injury from trauma, surgery, difficult or prolonged catheterization, and most commonly, infectious disease, particularly gonorrhea. Radical prostatectomy for treatment of prostate cancer is an excellent operation but not infrequently, a stricture can develop where the bladder is sewn directly to the urethra because the prostate, positioned between the two, has been removed. Most strictures have been treated by periodically inserting a dilating instrument through the stricture.

Recently, surgical methods of treatment such as cutting through the stricture from the inside through a special cystoscope and more recently open surgical repair of the stricture. Hollow stents made of special materials can be inserted and left indwelling within the stricture to permit a strong flow of urine. These stents function in a similar manner to the stents inserted into coronary arteries; the coronary stent permits blood to flow, while the urethral stent permits urine to flow. More recently, buccal grafts, the tissue in the mouth lining the inside of the cheek has been harvested, sewn into a tube and transplanted to fill the void created by the removal of the section of urethra containing the stricture.

A man may have both a urethral stricture and a benignly enlarged prostate so that dilating the stricture will not give relief because the obstructive prostate enlargement is still present. If the patient is treated with medication such as Avodart and/or Flomax and the prostate shrinks in size or relaxes its muscle tone, the stricture will not be affected and the symptoms will also persist. Both conditions require treatment.

If prostate microwave thermotherapy or surgery, whether open surgery, TURP, TUNA or LASER is performed, the stricture, which would of necessity have been dilated as part of the microwave thermotherapy or of the surgery, will eventually again contract and cause the symptoms to return. Periodic urethral dilation easily and comfortably done in the office may still be required to maintain an adequate urinary outflow pathway.

Have a question? Call Dr. Okun at 718-241-6767