A urethral stricture is a narrowing of the urethra from scar tissue, almost always in men, that blocks the flow of urine. Common causes are injury from catheters or instruments, pelvic or straddle trauma, past infections such as gonorrhea and lichen sclerosus, though many have no clear cause.
Key symptoms
- Slow, weak or spraying urine stream
- Straining, incomplete emptying and dribbling
- Repeated urinary infections or prostatitis
- Sudden inability to urinate
What you find on exam
- Palpable bladder if there is retention
- Inspect the opening for narrowing or white patches of lichen sclerosus
- Feel along the shaft for a firm scar
- Difficult catheter passage is a strong clue
Tests
- Uroflowmetry: low peak flow with a flat, plateau-shaped curve
- Post-void residual with a bladder scan
- Retrograde urethrogram to show where the stricture is and how long
- Cystoscopy; urinalysis and urine culture
Treatment basics
- Retention: suprapubic catheter if a urethral catheter will not pass; never force it
- Short stricture: dilation or internal urethrotomy
- Repeat endoscopic treatments often fail, so refer early
- Urethroplasty for long or recurrent strictures, with the best long-term results
- Treat infection, and lichen sclerosus with a topical steroid
Red flags
- Inability to urinate
- Fever with retention (infected urine)
- Falling kidney function or hydronephrosis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.