What is a urethral stricture?

The urethra is the tube that drains urine from the bladder to the outside of the body. In boys, the urethra starts at the lower portion of the bladder and continues through the penis. A urethral stricture is a narrowing in the urethra. This narrowing makes it difficult for urine to drain out.

The narrowing may be congenital (present at birth) or the result of inflammation, injury, disease or prior surgery.

Signs and symptoms

• Pushing or straining with urination
• Weak, prolonged, thin, or slow urinary stream
• Painful urination
• Urinary tract infection (UTI)
• Hematuria (blood in the urine)

Testing and diagnosis

• Uroflow: Your child will void into a special toilet, called a uroflow chair, that measures the urine flow rate and the time needed to empty the bladder. After that, we will check for any urine left in the bladder with a special ultrasound called a bladder scan. In children with a urethral stricture, the urinary flow rate is decreased and it usually takes longer to empty the bladder.
• Renal bladder ultrasound (RBUS): This procedure uses sound waves to outline the kidneys and bladder. It will enable us to see if any hydronephrosis or dilation of the kidneys and urinary tract is present.
• Retrograde urethrogram (RUG): A catheter (tube) is placed into the end of your child’s urethra (at the tip of the penis). The tube is then used to slowly fill the urethra with an opaque solution. While the solution is filling the bladder, a special X-ray machine (fluoroscopy) is used to take pictures. The radiologist looks to see if there is narrowing in the urethra. This will provide us with the location of the narrowing, the degree of narrowing and if any other malformations are noted.

Treatment

Treating the urethral stricture depends on the location and length of the stricture.

Surgical repair

• Cystoscopy : During surgery the urologist will insert an instrument into the urethra, called a cystoscope. A cystoscope is a small device with a light and a camera lens at the end. This provides direct visualization of the urethra and possible stricture.
• Endoscopic urethrotomy: While under general anesthesia, a cystoscope is inserted into the urethra through the penis. The stricture can be cut lengthwise with a blade, on the end of the instrument, to widen the urethra and allow urine to pass. The instrument can also be used to stretch the narrowed area of the urethra. A small tube called a catheter is left in place as the area heals.
• Urethroplasty: An open urethroplasty is more complex and may be necessary for longer strictures. This procedure involves an incision between the scrotum and rectum. The narrowed area of the urethra is removed and the remaining urethra is reconnected (anastamosis). When the stricture is too long, a tissue graft, most commonly from the inside of the mouth (buccal), may need to be used to increase the length of the urethra. Due to the complexity of this operation, there are times when the surgeon may recommend that the urethroplasty is done with a staged approach, meaning that more than one surgery will be required.