Urethral Reconstructive Surgery
Faculty
Christopher M. Gonzalez, MD, MBA
Director of Genitourinary Reconstruction
A urethral stricture is a scar occurring anywhere in the urethra, causing stenosis, or narrowing, of the urethral lumen. They are much more common in males than in females.
The urethra is the tube that runs from the base of the bladder out the tip of the penis in a male and out the superior portion of the vagina in a female. It is a conduit for the passage of urine and sperm for a male and urine for a female.
Causes of urethral strictures include:
- perineal trauma
- prior urologic procedures performed through the urethra
- sexually transmitted diseases
- pelvic irradiation for cancer
- hypospadias
- A common congenital anomaly where the urethral meatus (opening of the
urethra) projects on the penile shaft, rather than the tip of the penis (glans). - previous surgery for hypospadias
- lichen sclerosus
- A poorly understood inflammatory disease of the genitalia that cause scarring
on the penile shaft skin, the foreskin, the tip of the penis (glans), as well as the
urethra. If the urethral tissue is affected the urethra becomes stenotic (narrowed)
Furthermore, pelvic trauma associated with pelvic fracture can cause a separation of the urethra (commonly called pelvic fracture urethral injury or PFUI) just below the bladder and prostate, creating an extensive scar. However, the majority of urethral strictures are from unknown causes.
Urethral stricture is usually related to the impeded flow of urine as it moves from the bladder out the urethra. This can include weak or split urinary stream, sensation of incomplete bladder emptying, urgency of urination, or straining in order to complete urination. Other possible consequences include sexual dysfunction, recurrent urinary tract infections, and rarely bladder or kidney damage.
DIAGNOSIS:
Diagnosis of urethral stricture usually involves cystoscopy, a procedure where a small scope (cystoscope) is inserted into the urethra in order for the urologist to visually inspect the urethra and the bladder, as well as a retrograde urethrogram, which is an examination where contrast media (radio-opaque dye) is injected from the tip of the urethra up into the bladder and an x-ray is taken of the pelvis. This allows the urologist to inspect the entire urethra and visualize the length and location of the urethral stricture (see images).
TREATMENT:
Urethral strictures may be treated by endoscopic dilation or incision, procedures that utilize a cystoscope in the urethra. While these methods are less invasive, they are often unsuccessful, meaning that urethral strictures tend to recur after the procedure, either immediately or within months to years. Emerging data suggest that urethroplasty produces a more favorable outcome. Urethroplasty is a surgical procedure where the urethral stricture is excised (removed) and the urethra is reconstructed using various techniques, depending on the length and severity of the stricture.
The Northwestern genitourinary reconstructive surgery program is a leading force in the urologic community in management of urethral stricture disease. We have extensive experience with all the varied urethroplasty techniques and are actively conducting research to improve excellence in surgical outcomes.
