Urethral stricture – What are the signs and symptoms, relevant dDx., sequelae, work up, and treatment options?

Urethral stricture is a decrease in urethral caliber due to scar formation in the urethra (possibly involving the corpus spongiosum), and can be caused by congenital abnormality, trauma or infection.

Sn. & Sx.:

• Voiding symptoms (hesitancy, post-void dribbling, incomplete voiding)
• Urinary retention
• Infections (recurrent urinary tract infection, prostatitis, epididymitis)

dDx.:

• Infection (cystitis, urethritis, prostatitis, epididymitis, orchitis, cervicitis, vulvovaginitis, vestibulitis)
• Neoplasm (renal cell, bladder, prostate, genitals)
• Calculi (bladder, ureter, kidney)
• Inflammation (Reiter’s syndrome, autoimmune disorders, pelvic inflammatory disease, interstitial cystitis)

Sequelae:

• Retention
• Overflow incontinence
• Hydronephrosis and renal compromise
• Infection
• Renal colic, calculi

Work up:

• Urinalysis
• Uroflowmetry (decreased flow rates)
• Digital rectal exam (prostate is smooth, rubbery and symmetrically enlarged)
• Prostate-specific antigen test

Tx.:

• Urethral dilation
• Surgical reconstruction

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This post was written by Omar Rifai