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Urethral stricture: narrowing of urethral lumen

Urethral stricture Topic
FB Dr Soarawee
Soarawee Weerasopone, MD

Andrologist
Royal Phnom Penh hospital, Kingdom of Cambodia

Urethral stricture is a common presentation symptom at my Urology office. It is defined as a narrowing of a segment of the urethra. There was a report from US showing 0.9% incidence among men that will dramatically increasing after age 65.

Urethral stricture: narrowing of urethral lumen
Long term of urethral catheterization is 1 of the urethral stricture cause.

The etiology of urethral stricture can be divided into 4 major causes.

  1. Idiopathic
    • 33% incidence
    • Being reported more in younger male
    • Unrecognized childhood trauma or congenital anomaly
  2. Iatrogenic
    • 33% incidence
    • History of transurethral endoscopic surgery
    • History of long-term indwelling urethral catheter
  3. Inflammatory
    • 15% incidence
    • History of urethral infection such as STDs
  4. Traumatic
    • 19% incidence
    • History of blunt straddle injury
    • History of pelvic fracture
    • History of penile fracture
Pelvic fracture
Urethral stricture can be the consequence after traumatic pelvic fracture.

Once the urethral lumen was damaged by any kind of above etiologies, then the scarring formation will gradually occur resulting in narrowing urethral canal. This process will spend weeks, months or a year depends on individuals.

Patients will more often visiting my office with a weak urinary stream or discomfort during urination in addition of its risk factors as I have mentioned above. Then, the visualized cystoscopy will be recommended and follow by a contrasted study of urethra if necessary.

Poor stream
Weak urinary stream is major presentation symptom of urethral stricture.

Next step, the discussion with patients about the options of treatment relevant to postoperative surveillance plan, because we’re dealing with scarring formation that possibly can be recurred in the future.

Here are the treatment modalities on urethral stricture.

Laser technology
Advance laser technology can be used in urethral stricture treatment.
  1. Urethral dilation
    • Serial dilation with metallic dilator is frequently managed by Urologist with comparative result and recurrence rate comparing with operation.
    • 60% recurrence rate at 48 months of following up.
  2. Direct vision cold knife urethrotomy
    • Cold knife incision of urethral stricture under visualized is a common surgery technique among other for Urologists.
    • 50% recurrence rate at 48 months postoperatively.
  3. Direct vision laser urethrotomy
    • Same module as the above modality but change from a cold knife to a laser technology
    • Comparative outcome
  4. Urethroplasty
    • Gold standard for urethral stricture which more than 2 cm of length.
    • Higher long-term success rate.
Urethroplasty
If long urethral stricture tract is encounter, open surgery shows the best outcome.

As I have mentioned before, we’re dealing with a natural scarring formation process, so the important method is a regular following up and earlier detection in case of recurrence. Any questions, you can discuss with your trusted Urologist or it would be my honor if you text me. Take care!

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