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Urethral Stricture
Anatomy
Posterior urethra• Prostatic urethra• Membranous urethra
Anterior urethra• Bulbar urethra• Penile urethra
Causes
•Congenital•Traumatic•Inflammatory•Instrumental•Post operative
Pathology:
• Urethral lumen is narrowed due to periurethral fibrosis and scarring• Composed of dense collagen and
fibroblasts• Fibrosis may extend into the
surrounding spongiosum - spongiofibrosis
Clinical features
•Poor urinary stream•Straining to void•Dribbling of urine• Increased urinary frequency• Incomplete bladder emptying•Urinary retention
Signs:
• Induration of the area of stricture• Periurethral abscess - Tender
swelling along the urethra• Urethrocutaneous fistula• Palpable bladder• Enlarged kidneys
Complications
• Retention of urine• Urethral diverticulum• Periurethral abscess• Urethral fistula – watering can
perineum• Hydroureteronephrosis• Trabeculations , diverticula• Prostatitis• Calculus• Hernia , hemorrhoids , rectal prolapse
Investigations
•Urine microscopy•Urine C/S•Urosonology and PVR•Uroflowmetry ( < 10 ml /sec)•Urethrogram or voiding
cystogram
Treatment• Dilatation Metal dilators Gum elastic bougie• Urethrotomy – VIU Followed by self dilatation • Urethral stents• Urethroplasty < 2 cms – direct anastomosis > 2 cms – Full thickness skin graft Pedicled skin flaps Penile skin Scrotal skin Buccal mucosal flap
Summary
• Anatomy
• Causes
• Pathology
• Clinical Features
• Complications
• Investigations
• Treatment