What is Urethral Stricture
Urethral stricture is a condition in which the urethral tube narrows due to scar tissue (spongiofibrosis). Classified by location: anterior urethra (penile, fossa navicularis, bulbar) and posterior urethra (membranous, prostatic).
Prevalence: ~0.9% in the general population; far more common in men due to longer urethral length (~20cm vs 4cm).
Causes
- Iatrogenic (~45%): catheterisation, endoscopic procedures (TURP, TURBT, URS), intraoperative trauma.
- Idiopathic (~30%): no identifiable cause.
- Inflammatory (~15%): prior gonococcal urethritis, lichen sclerosus (BXO).
- Traumatic (~10%): pelvic fractures, straddle injuries, cycling trauma.
Symptoms
- Weak or thin urinary stream (key symptom).
- Intermittent voiding, double or scattered stream.
- Prolonged voiding time.
- Hesitancy, abdominal straining to void.
- Sensation of incomplete emptying, post-void dribbling.
- Recurrent urinary tract infections (UTIs).
- Painful urination, haematuria.
- Severe obstruction: acute urinary retention.
Diagnosis
1. Uroflowmetry
First step. Qmax <10 mL/s with characteristic plateau pattern (instead of the bell-shaped curve).
2. Retrograde urethrography (RUG)
Gold standard. Defines exact location, length and number of strictures — essential for surgical planning.
3. Voiding cystourethrography (VCUG)
Complementary for posterior strictures and bladder emptying assessment.
4. Flexible urethroscopy
Direct visual confirmation and assessment of spongiofibrotic tissue.
Treatment Options
Urethral dilation
Old method for transient relief. Recurrence >90% at 1 year. Not recommended as definitive treatment.
Direct Vision Internal Urethrotomy (DVIU)
Endoscopic incision of the stricture with cold knife or laser. Indicated only for first-episode, short strictures <1cm in the bulbar urethra. Recurrence 50–60% at 1 year, >80% in repeat procedures.
Optilume® Drug-Coated Balloon
Revolutionary new technique: paclitaxel-coated balloon (anti-fibrotic) that dilates and locally releases drug. Stricture-free rate ~75% at 2 years. Ideal for recurrent strictures <3cm.
Urethroplasty
Gold standard for definitive cure. Success rate 85–95% at >10 years.
- Anastomotic urethroplasty: stricture excision + primary anastomosis. For bulbar strictures <2cm.
- Buccal mucosa graft (BMG): oral mucosa graft. For strictures >2cm. Best graft due to elasticity and resistance to urinary environment.
- Skin graft/flap: alternatives for anterior strictures.
Prevention & Follow-up
- Prompt and proper urethritis treatment — prevention of post-inflammatory stricture.
- Atraumatic catheterisation with appropriate catheter size.
- Surveillance after TURP/TURBT for early stricture detection.
- Postoperative follow-up: uroflowmetry at 3, 6, 12 months and annually.
- Clean intermittent self-catheterisation (CIC) in selected cases for lumen maintenance.
Frequently Asked Questions about Urethral Stricture
What is urethral stricture?
It is a narrowing of the urethral lumen caused by fibrotic scar tissue (spongiofibrosis) that restricts normal urine flow. More common in men due to the longer urethra.
What are the symptoms?
Weak urinary stream, intermittent flow, prolonged voiding time, sensation of incomplete emptying, post-void dribbling, recurrent urinary tract infections, haematuria.
How is it diagnosed?
Uroflowmetry (Qmax <10 mL/s, characteristic plateau curve), retrograde and voiding urethrography (RUG/VCUG) for length and location mapping, urethroscopy for direct visual confirmation.
What are the treatment options?
Dilation/internal urethrotomy (DVIU): for short strictures <1cm, high recurrence rate. Urethroplasty (Optilume® drug-coated balloon, anastomotic, or buccal mucosa graft): definitive treatment with 85–95% success for strictures >2cm or recurrent.
Is internal urethrotomy a permanent fix?
No. DVIU has high recurrence (~50% at 1 year, >80% in recurrent strictures). Urethroplasty remains the gold standard for definitive cure.
Conclusion
Urethral stricture requires individualised treatment. Modern Optilume® and urethroplasty offer definitive solutions with high success rates and preserved sexual function.
Scientific References
- EAU Guidelines on Urethral Strictures 2024 — uroweb.org
- Wessells H et al. Male Urethral Stricture: AUA Guideline. J Urol 2017;197:182-190.
- Mundy AR, Andrich DE. Urethral strictures. BJU Int 2011;107:6-26.
- Elliott SP et al. The ROBUST III randomized controlled trial of Optilume® drug-coated balloon. J Urol 2022;207:866-875.
Meet the Doctor
Dr. Marinos Vasilas, Urological Surgeon – Andrologist
Specialising in urethral strictures: Optilume® drug-coated balloon, internal urethrotomy and buccal mucosa graft urethroplasty.
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