What Causes Urethral Stenosis? Urethral Stricture Symptoms and Treatment

Urethral stenosis is a condition in which there is a stenosis in the urethra, which is a tube-shaped structure located between the bladder and the urinary outlet. The urethra is wide enough for urine to flow freely through it under normal conditions, but when there is a narrowing in the urinary tract, the flow is interrupted. This health problem, which is mostly seen in men, negatively affects the entire urinary system (urinary excretion system) function and can lead to very serious consequences such as kidney loss. Its prevalence among men in developed countries is approximately 0.9%.

What is Urethra?

For those wondering what urethra means, urethra is the tube-shaped urinary canal that starts from the bladder and allows urine to be excreted from the body. It is a long tube that passes through the penis in men and is responsible for carrying semen as well as urine. In women, it is much shorter than in men and is located just above the vagina. Urethral problems may occur in both genders for different reasons such as aging, disease or trauma. The urethra starts from the bladder and opens to the outside of the body. The urinary system also has a pair of tube-shaped urinary ducts called ureters, which extend from each kidney to the bladder. Like the urethra, ureteral strictures are important disorders of the urinary system. Ureter and urethra stenosis, if left untreated, can lead to serious diseases such as kidney infections and kidney stones.

What is Urethral Stenosis?

Urethral stricture is an obstructive disorder that impairs urination function as a result of narrowing of the urethra due to scar tissue or swelling, and has potentially serious consequences for the entire urinary tract. Scar tissue is a scar that forms during the healing of wounds on the body and contains cells with a different structure than the normal tissue in the area. Urinary stenosis caused by scar tissue in the urethra causes obstructive and irritating urinary symptoms and, if left untreated, can eventually lead to a life-threatening complication such as kidney loss. Urethral strictures may occur as a negative consequence of some medical procedures performed for diagnostic or therapeutic purposes.

What Causes Urethral Stenosis?

Urethral stricture may occur due to swelling or scar tissue developing in the canal due to surgical procedures, or it may occur after infection or injury. Rarely, the pressure of a tumor formation near the urethra on the canal is the cause of stenosis. Urethral manipulation is the most common cause of urethral stricture. Approximately 45% of urethral strictures occur due to urethral manipulation such as endoscopy, surgery, and brachytherapy, while the cause of 30% cannot be found. 20% of it is caused by infections that cause inflammation in the urethra. Factors that can be considered as causes of urethral stenosis include:

• Entering the urethra with an endoscopy or similar instrument
• Prostate Brachytherapy: Receiving brachytherapy treatment for prostate cancer may result in stenosis in the urethra. Brachytherapy is a type of radiotherapy.
• Prostatectomy: Surgical procedure in which part or all of the prostate gland is removed.
• Urethral Catheter Insertion: Intermittent or permanent catheter insertion into the urethra to drain urine from the bladder.
• prostate enlargement
• Prostatitis: Inflammation in the prostate
• Injury or trauma to the groin area or urethra
• Urethral or prostate cancer
• Sexually Transmitted Diseases: Sexually transmitted diseases such as gonorrhea and chlamydia can cause urinary tract narrowing if left untreated.
• Bacterial Infections: Untreated recurrent infections can cause stenosis due to inflammation.
• Hypospadias Surgical Treatment: Hypospadias is a congenital anomaly in which the urethral opening is located under the penis instead of at its tip.
• Balanitis Xerotica Obliterans: It is a lichen sclerosus disease that affects the penis in men. It causes inflammation of the foreskin and glans penis.
• hip fractures
• Congenital Anomaly: Rarely, babies may be born with stenosis in the urethra due to a congenital defect.

What are the Symptoms of Urethral Stenosis?

Urethral stricture can present with many symptoms, ranging from mild to severe, depending on the degree of obstruction in the duct. Some of these symptoms may include:

• Weakness in urine flow
• Decrease in the amount of urine
• Frequent need to urinate
• Feeling of incomplete emptying of the bladder after going to the toilet
• Burning while urinating
• Loss of bladder control and urinary incontinence
• urethral discharge
• dark urine
• blood in urine
• sudden need to urinate
• Pain while urinating
• Prolongation of urination time
• inability to urinate
• Having frequent urinary tract infections
• Pain, swelling, blood in the semen and prostate inflammation in the penis and surrounding tissue in men

Due to urethral stenosis, urine leaks back into the bladder, and if this becomes chronic, the bladder may enlarge and become dysfunctional over time. Urine may leak back into the kidneys, causing a condition called hydronephrosis and kidney loss. If a person is unable to urinate, this is a serious and urgent situation. If you have this symptom, it is vital to contact a healthcare provider immediately.

How is Urethral Stenosis Treatment?

The treatment of urethral stricture is decided according to the findings obtained by tests and imaging methods. Treatment options include:

• Urethral Catheterization: A catheter, that is, a urinary catheter, is inserted into the urethra to drain the urine accumulated in the bladder due to obstruction. It is a treatment option for cases of temporary stenosis formation.
• Urethral Dilatation: It is a treatment method that can be preferred in those with recurrent urethral stricture problems. It is done to prevent recurrence of stenosis after treatment. It is the process of widening the urethra by using rigid catheters at regular intervals. The purpose of urethral dilation is to stretch scar tissue without damaging the lining of the urethra.
• Urethroplasty and Urethral Reconstruction: It is the most permanent treatment option for urethral stricture. It can be done in two ways: cutting out the narrow urethra part, stitching the remaining healthy ends end to end, or reconstructing it with tissues taken from other parts of the body.
• Endoscopic Urethrotomy: A wire called cystoscope with a lighted camera at the end is entered into the urethra. The stenosis is widened by cutting or laser burning.
• Implantable Stent or Permanent Catheter: In patients with a severe stenosis who do not want to undergo surgery, treatment can be done by placing a permanent stent to keep the urethra open or a permanent catheter to drain the bladder. However, these methods have several disadvantages, such as bladder irritation and the risk of urinary tract infection.

What is the Recovery Process After Urethral Stenosis Surgery?

Urethral stricture surgery can be performed in two different ways: urethroplasty or endoscopic urethrotomy. Recovery time after urethral stricture surgery varies depending on the procedure performed, the duration of catheterization of the patient and the general health condition. After almost all surgeries performed for the treatment of urethral stricture, a catheter (urinary catheter) is left in the urethra. How long the catheter will remain in place is determined by the procedure performed and the doctor’s decision.

What Happens If Urinary Tract Stenosis Is Not Treated?

If urethral stricture is not treated, it can lead to serious diseases such as kidney infections and kidney stones. By blocking urine output, it can cause urine to accumulate in the urinary tract, thus leading to impaired bladder function and kidney damage.

Why Does Urethral Stenosis Recur?

In urethral strictures, the risk of recurrence varies depending on the length of the stricture, its location, the density of the connective tissue formed around the stricture, and the type of surgery performed. The risk of recurrence of stenoses longer than 1 cm is quite high. If the connective tissue around the stenosis is dense, the risk of recurrence is high. Urethroplasty for urethral stricture is the longest-lasting treatment method, regardless of the type of surgery performed. However, although rare, there is still a risk of the disease recurring after a while. Therefore, before surgery, patients should be appropriately informed about the potential for recurrence of the condition. Endoscopic urethrotomy is preferred due to faster recovery, minimal scarring and less risk of infection, but the risk of recurrence of the stricture is higher. The disease recurs within two years after the operation in at least half of the patients.

It is recommended that you do not neglect regular health check-ups for early diagnosis and treatment.