What is a urethral stricture?
A urethral stricture occurs when the urethra—the tube that carries urine from the bladder out of the body—becomes narrower than usual, making urination (peeing) difficult.
In men and women, the urethra can be compared to a hose, carrying fluid (urine or pee) from your body’s collection tank (the bladder) to the tip of the urethra, where it comes out when you urinate. The fluid won’t run smoothly whenever there’s a kink in the hose or a section where the space inside – or lumen – is narrower. Instead, the fluid can accumulate just before the kink or flow more slowly as it struggles to pass through the blockage.
Although most often diagnosed in men, female urethral stricture disease is hardly unheard of, with some estimates indicating that it may be involved in up to 8% of all cases of women with frequent urinary symptoms.
In some cases, urethral stricture disease can cause recurrent urinary tract infections (UTIs), painful or slow urination, and even a complete blockage. So, what lies behind this relatively unknown disease?
Urethral stricture disease symptoms
Urethral stricture disease can cause any of the following symptoms:
- A weak, dribbling, or slow urine stream.
- Feeling like your bladder is still full, even right after voiding (peeing).
- Urinating in droplets or with a spraying stream.
- Constant leaking from the urethral opening.
- Painful urination.
- Very dark urine.
- Blood in the urine (hematuria).
- Frequent UTIs.
- Incontinence.
Urethral stricture disease complications
If left untreated, a urethral stricture can cause the urine to “back up,” causing urine to accumulate in the bladder. Known as urinary retention, this can potentially create more serious issues, such as:
- Hydronephrosis or kidney swelling
- Kidney damage
- Bladder dysfunction
- Bladder stones
- Kidney stones
- In women, a fistula (opening) may form between the urethra and the outside vaginal wall
In some cases, people with untreated urethral stricture disease can also develop acute urinary retention or a sudden and painful inability to pass urine at all. This is a medical emergency, as it can severely damage the kidneys and may even be fatal.
How is female urethral stricture disease different from the same condition in men?
Men have a much larger urethra: it starts in the bladder, passes through the prostate gland, and then continues through the pelvic floor and the penis (spongy or penile urethra). Depending on whether the penis is erect or not, the urethra may also be in charge of transporting semen during sexual intercourse. On average, this path is about 7 to 8 inches long.
On the other hand, an adult woman’s urethra is typically only 1.5 inches long. It is only meant to transport urine, making it slightly narrower than a man’s.
These differences have two distinct consequences. First, they make male urethral strictures much more common, as the hose has many more points in which to kink. Second, a woman’s shorter and thinner urethra is more susceptible to developing a complete blockage. A shorter hose also increases the risk of urine backing up into the bladder, leading to complications.
Causes of urethral stricture disease
Often, a urethral stricture is caused by scar tissue that has formed inside the urethra over time. The most common causes of this include:
- Physical trauma, such as pelvic fractures or straddle injuries (when you fall onto a hard object with the legs open, straddling it)
- Injuries during childbirth
- Micro-tears following catheterization
In addition, the narrowing of the urethra can also happen due to chronic inflammation. Some of the risk factors for this include:
- Localized radiation therapy after cervical cancer.
- Sexually transmitted infections, such as chlamydia or gonorrhea.
- Lichen sclerosus, a rare skin disorder that causes itchy patches of skin near the genitals.
- Pelvic inflammatory disease is an infection of the female upper reproductive organs.
Finally, we also need to remember the effect of female hormones. As women age, decreased estrogen levels can narrow the urethral meatus (the opening of the urethra, halfway between the clitoris and the vaginal opening.)
How do we diagnose urethral stricture disease?
A urologist usually diagnoses urethral stricture disease. Women who suspect they may have this condition are often referred by a gynecologist or their primary healthcare provider.
The diagnosis process always starts with a thorough interview. After discussing your symptoms, medical history, and risk factors, we will conduct a physical examination, which typically includes a pelvic exam and a urinalysis.
Often, urologists need to order extra tests to understand the severity and length of the stricture. These may include:
- Urodynamic studies to check your bladder pressure while you are voiding.
- A retrograde urethrogram is a type of X-ray that targets the inside of the urethra.
- Urine flow tests measure the flow rate (the speed of urine) when voiding the bladder.
Finally, most urologists will want to examine the bladder with cystoscopy and urethroscopy. These tests involve inserting a tiny camera up your urethra and into the bladder using a thin, flexible tube. They are often done under general or spinal anesthesia (when you lose sensation from the waist down).
Urethral stricture disease treatment
Nowadays, we have a relatively wide range of treatment options for female urethral strictures. Depending on the severity and location of the stricture, we will determine the path that relieves your symptoms for the longest possible time while minimizing the risk of complications.
Conservative management of urethral stricture
We usually start with simpler, minimally invasive, or endoscopic procedures in milder cases. Two of the most common ones are:
- A urethral dilation that involved progressively “stretching” the stricture.
- A urethrotomy is performed by inserting a cystoscope with a small knife at the tip. Then, we make small cuts inside the urethra, near the narrowed area, to widen the stricture.
These procedures can usually be done at your doctor’s office with local or spinal anesthesia. In many cases, they can quickly improve urine flow. However, it may take a few weeks for you to notice any changes in urinary frequency and for the pain to go away completely.
Unfortunately, these results may not be permanent. Approximately 24 months after a urethrotomy, only 60% of women continue to see good urinary flow. At 48 months, the success rate falls further to 50%.
The procedure can be repeated a second time, although success rates will dwindle further: 24 months after a second urethrotomy, only 30% of patients remain symptom-free. At this point, it is usually necessary to explore other options, as any further cuts will likely provide no benefit. Additionally, the resulting scar tissue increases the risk of a severe blockage.
Surgical procedures for female urethral stricture disease
We can perform a urethroplasty or open urethral reconstruction for more severe or recurrent strictures.
This very specialized procedure requires an experienced surgeon to choose the proper technique and method. It may involve:
- Using a buccal mucosa skin graft to create a new urethra.
- Reconstructing the damaged part of the urethra using a skin flap.
- Cutting the damaged section of the urethra and reconnecting the rest (anastomotic urethroplasty).
Studies show that, when performed competently, urethral reconstructions have a success rate of between 80% and 100%. This procedure is more likely to be effective if performed after the first urethrotomy has failed rather than after a second one.
Several of our professionals at Tower Urology have extensive experience with female urethral reconstructions.
Dealing with a urethral stricture? See us at Tower Urology!
At Tower Urology, we take a personalized, evidence-based approach to general urology care. All our professionals are committed to providing you with caring, expert care, including follow-up. We take the time to understand you and personalize your treatment plan to your needs.
We invite you to establish care with Tower Urology.
Tower Urology is conveniently located for patients throughout Southern California and Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include treatment for pelvic organ prolapse, menopause/hormone management, chronic pelvic pain syndrome in women, shockwave therapy for pelvic pain, interstitial cystitis, lichen sclerosis and planus, urethral diverticulum, urethral stricture disease, urinary fistulas, and vaginal mesh complications.
Urethral Strictures FAQ
The most common cause of urethral stricture is injury from medical procedures, especially catheterization or surgery. Other causes include trauma infections (like STIs). However, sometimes the cause is unknown.
You can live with a urethral stricture, but it’s not safe. Untreated strictures can cause serious problems like infections, bladder or kidney damage, and even kidney failure. It’s important to see a doctor for proper treatment.
Sources
Urethral Stricture Disease: Symptoms, Diagnosis & Treatment
https://www.urologyhealth.org/urology-a-z/u/urethral-stricture-disease
Buccal epithelium Expanded and Encapsulated in Scaffold‐Hybrid Approach to Urethral Stricture (BEES‐HAUS) procedure: A novel cell therapy‐based pilot study
https://pmc.ncbi.nlm.nih.gov/articles/PMC7379713
Intermittent self‐dilatation for urethral stricture disease in males
https://pmc.ncbi.nlm.nih.gov/articles/PMC10880810
Urethral Stricture: Etiology, Investigation and Treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC3627163
