Urethral stricture

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Editors-in-Chief: Joel Gelman, M.D. [mailto:jgelman@uci.edu], Director of the Center for Reconstructive Urology and Associate Clinical Professor in the Department of Urology at the University of  California, Irvine and Brad Figler, M.D., Resident, Emory University Department of Urology [mailto:figler@gmail.com]

Overview
A urethral stricture is internal damage to the urethra caused by injury, such as straddle or pelvic fracture trauma, or disease such as Balanitis Xerotica Obliterans.

Presentation
During the early stages of the condition, the subject may experience a diminished urinary flow rate, pain during urination, and/or the inability to fully empty the bladder. It is not uncommon for the bladder's capacity to significantly increase due to this inability to completely void.

Urethral strictures may cause problems with urination, including in certain cases the complete inability to urinate, which is a medical emergency.

Causes
Urethral strictures are generally caused by trauma such as straddle injury (bicycle bar, sports injury, fence straddle). These strictures are located in a portion of the urethra proximal to the penis that is under the scrotum, called the bulbar urethra.

When there is a fracture of the pelvis, this bone fracture can in some cases be associated with a complete transection of the urethra just below the prostate. The body's attempt to repair the damage caused by the injury creates a buildup of scar tissue in the uretha resulting in a significant narrowing or even closure of the passage.

Other causes of strictures include a skin disease called Balanitis Xerotica Obliterans, an inflammatory disorder that affects the penile skin and can lead to severe progressive stricture disease. The urethral stricture is often just at the tip of the pnie initially. However, this disease, especially when there is a delay in diagnosis, can progress to cause a stricture of the entire anterior urethra, called a pan-urethral stricture.

Other causes of urethral strictures include urethral instrumentation with cystoscopes (telescopes advanced through the urethra to visualize the bladder). Incomplete development of the urethra at birth is called hypospadias, and urethral strictures can develop as a complication of surgery to reconstruct the urethra. Although infections and STDs are possible causes of urethral strictures, infections are generally not the cause of urethral strictures. In addition, urethral strictures are rarely, if ever, congenital.