Synonyms
Urethral narrowing, urethral strictureUrethral stricture is a pathological narrowing of the urethra. A basic distinction is made between a congenital and an acquired narrowing. Due to anatomical conditions, men are affected by urethral stricture far more frequently than women
Congenital causes
Malformations of the external genitals are often the reason for a congenital urethral stricture. For example, the urethra itself can be affected by a developmental disorder. This is known in medicine as hypospadias.
In this case the urethral orifice is located further forward and closer to the body. Often a curvature of the penis and a splitting of the foreskin occur simultaneously. Due to the displaced mouth of the urethra, micturition (urination) is more difficult, as the urine stream tends to run down the back of the urethra.
Acquired causes
The most common causes of urethral stricture are those that occur after injury. In this case, subtle microtraumas play a major role. These minimal injuries can occur, for example, during catheterization.
Placing a bladder catheter can cause minor injuries in the urethra. These small tears can heal in a scarred manner so that the scar tissue grows into the lumen of the urethra. Similar injuries also occur during endoscopic procedures such as cystoscopy.
The so-called straddle trauma is another possibility to get a urethral narrowing. These are blunt and direct traumas in the area of the perineum. They can occur while riding a bicycle, among other things.
Injuries to the urethra and bladder can also occur during a traffic accident. In the case of pelvic bone fractures, depending on the severity of the injury, a complete rupture of the urethra or bladder as well as prostate can occur. The more severe the injury, the larger the subsequent scar.
In some cases, a complete closure of the urethra may even occur. If a urethral narrowing is suspected, various diseases should be taken into consideration in the course of diagnostics and should therefore be examined more closely. These include benign enlargement of the prostate, tumors near the urethra and bladder and prostate cancer.
Depending on the location and size of surrounding tumors, these can lead to a narrowing of the urethra and disturb micturition. Furthermore, infections such as urethritis or infectious diseases such as gonorrhea can also impair the function of the urethra by causing inflammation and damage to the mucous membrane. The first symptoms often occur years after the acquired injury to the urethra.
The first sign and also the main symptom is a significant weakening of the urinary stream. This can be of varying severity. The urinary stream itself can be twisted or even split, which indicates an obstruction in the course of the urethra.
In the course of time, the weakening can increase in severity until finally urinary retention occurs. The patient is then no longer able to empty his usually completely filled bladder. In many cases, strong pain in the lower abdomen then occurs.
The urine then not only accumulates in the bladder, but can in extreme cases develop into a backwater that can reach the renal pelvis. This considerably impairs the function of the kidneys and can lead to kidney failure. This is a life-threatening situation and should be treated medically immediately.
Permanent urination against a resistance leads to a thickening and enlargement of the bladder muscle over time (bladder hypertrophy). This reduces the elasticity of the bladder and leads to a deterioration of the emptying function. Most patients also report difficult urination, which requires more effort.
At the same time, they only urinate a little and therefore have to go to the toilet more often than normal. They often feel the urge to urinate because they always retain residual urine in the bladder. If there are infections or inflammations, this can be detected in the urine blood. This is called microhaematuria and can be detected by means of a quick test. If a urethral stricture remains unnoticed and untreated, this can ultimately lead to uncontrolled urine loss, known as urinary incontinence.
