Urethral stricture is a serious urological condition that occurs when the urethra (the tube that carries urine from the bladder) narrows for various reasons. Normally, urine flow is smooth and uninterrupted, but scar tissue (scar tissue) forms on the urethral wall, obstructing this flow. The more pronounced the narrowing, the more difficult it becomes to pass urine. Over time, this can lead to symptoms such as difficulty urinating, weak urine flow, frequent urination, and a feeling of incomplete bladder emptying.
Causes of Urethral Stricture
Urethral stricture can have many causes. The most common causes include infections (especially sexually transmitted infections such as gonorrhea), trauma, surgical procedures, and long-term catheter use. In some cases, the cause cannot be determined and these cases are called "idiopathic."
Approximately 10% of urethral strictures are due to a chronic skin disease called lichen sclerosus. This condition usually occurs in the glans penis and is known as balanitis xerotica obliterans (BXO). Lichen sclerosus is more common in men with hypertension, diabetes, obesity, and smoking. Clinical studies have shown that the average age of these patients is around 45–50, and the strictures are usually long-segmented.
Symptoms of Urethral Stricture
Urethral stricture is a slowly progressive condition that may go unnoticed in the early stages. The most common symptoms include a weak or intermittent urine stream, burning or pain during urination (dysuria), urine change, blood in the urine (hematuria), and frequent urination. Some patients may experience recurring urinary tract infections or increased nocturia due to incomplete bladder emptying. This condition negatively impacts quality of life and, if left untreated, can even impair kidney function.
Diagnostic Methods
The first step in diagnosing a urethral stricture is taking a detailed history. Uroflowmetry is performed to assess urine flow rate. Retrograde urethrography is then performed to determine the location and length of the stricture. In recent years, MRI urethrography has also provided important information, particularly in the evaluation of posterior urethral strictures. Cystoscopy, however, is generally used for therapeutic purposes rather than diagnostic purposes, directly visualizing the narrowed area or performing procedures.
Treatment of Urethral Strictures
Urethral strictures do not resolve spontaneously; they necessarily require medical or surgical intervention. For mild strictures, the first option is usually dilation, or widening the urethra with special bougies. However, this method does not provide a permanent solution and carries a high risk of recurrence. For more permanent results, an internal endoscopic urethrotomy can be performed, which involves making a small incision in the narrowed area to restore urinary tract patency.
For long or recurring strictures, open urethroplasty is preferred. In this procedure, the narrowed segment is removed and the ends of the urethra are reconnected or the urethra is reconstructed using tissue grafts taken from the oral mucosa. Regular postoperative follow-up and care minimize the risk of recurrence.
Conclusion
Urethral stricture is a condition that can be effectively treated when detected early, but can lead to serious complications if neglected. Men experiencing symptoms such as decreased urine flow, frequent urination, or pain during urination should consult a urologist immediately. Early diagnosis and appropriate treatment can both improve quality of life and prevent potential kidney damage.