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