Urethral and Ureteral Strictures

Urethral and ureteral strictures are the scarring of the narrow tubes that carry urine through your body. The ureters carry urine away from the kidneys to the bladder, and the urethra is the tube that carries urine from the bladder to the outside of the body. Strictures in these tubes restrict the flow of urine and can cause a variety of medical problems in the urinary tract including inflammation and infection.

Signs and symptoms of urethral stricture include:

• Decreased urine stream
• Incomplete bladder emptying
• Spraying of the urine stream
• Difficulty, straining or pain when urinating
• Increased urge to urinate or more-frequent urination
• Urinary tract infection

Treatment

Corrective treatment is only necessary if the stricture is causing problems.

Treatment will depend on your unique situation, but your options may include:

• Urethroplasty
  This involves surgically removing the narrowed section of your urethra or enlarging it. The procedure might also involve reconstruction of the surrounding tissues. Tissues from other areas of the body, such as your skin or mouth, may be used as a graft during reconstruction. The recurrence of urethral stricture after a urethroplasty is low.
• Endoscopic urethrotomy
  For this procedure, your doctor inserts a thin optical device (cystoscope) into your urethra, then inserts instruments through the cystoscope to remove the stricture or vaporize it with a laser. This surgical procedure offers a faster recovery, minimal scarring and less risk of infection, although recurrence is possible.
• Dilation
  Your doctor inserts a tiny wire through the urethra and into the bladder. Progressively larger dilators pass over the wire to gradually increase the size of the urethral opening. This outpatient procedure may be an option for recurrent urethral strictures.
• Catheterization
  Inserting a small tube (catheter) into your bladder to drain urine is the usual first step for treating urine blockage. Your doctor might also recommend antibiotics to treat an infection, if one is present. Self-catheterization might be an option if you're diagnosed with a short stricture.

Generally, whenever urethroplasty is possible for treating urethral stricture, doctors prefer that procedure over other surgical treatments. The conventional wisdom is that performing urethroplasty early during the course of treatment spares you from needing multiple endoscopic urethrotomies, if urethral stricture recurs.