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Causes of Stricture

Infection:

Instrumentation/urological procedure:

Endoscopic procedures: any type of endoscopic urethral instrumentation (TURP, TUIP, and HOLEP) may cause a urethral stricture.

Urethral catheter: any type of urethral catheter may cause urethral strictures. The incidence of a urethral stricture following catheter is high in patients who underwent cardiovascular surgery or who were cared for in the resuscitation recovery room.

Prostate surgery or radiation can be associated with complex strictures involving the bladder neck and/or membranous urethra

Hypospadias surgery:

Hypospadias is a congenital disorder which present with incompletely developed urethra. Surgery for hypospadias repair can lead to urethral stricture.

Lichen Sclerosis/ Balanitis xerotica Obliterans (BXO):

It presents with whitish discoloration of skin of penis, scrotum and glans. It is an acquired disease of penis and urethra

It can progress to fibrosis and hardening of penile skin and glans, smoothing of the indentation between the head of the penis and shaft leading to urethral opening moving towards the undersurface of penis with induration and narrowing

It causes phimosis (narrowing of skin at tip of penis with stenosis of urethra opening) and stricture urethra. Stricture can be short and limited to urethral opening or can involve whole of anterior urethra. The classical appearance of male anterior urethral stricture associated with LS is that of a saw-toothed appearance throughout the involved area, with an area of perfectly normal anterior urethra proximally. Patient presents with both local as well as voiding symptoms. Itching is frequently reported, loss of glans sensation is likewise reported, and erections are often painful because of the scar Limitation and limitation of the expansion of the penile skin due to scarring, particularly the area of the frenulum. Voiding complaints such as dysuria, urethral discharge, and obstructive lower urinary tract symptoms are frequent.

It is one of the major causes of stricture urethra in developed countries.

Any person having whitish patch over penis which is not resolving or increasing should consult urologist.

Treatment of Lichen sclerosis/ Balanitis Xerotica Obliterans (BXO):

When a patient first notice skin changes or comes to us for narrowing of external urethral opening we evaluate patient by complete external genitalia examination, urethral imaging (RGU) and cystoscopy.

Circumcision is no guarantee that the LS process will settle and not progress

Short meatal strictures are managed by meatotomy or meatoplasty using buccal mucosa.

Meatal stenosis with anterior urethral stricture (partial / pan urethral) are managed by buccal mucosa augmented urethroplasty.

Skin lesion responds to topical steroids (0.05% clobetasol propionate cream) two to three times a day for 6-8 weeks but it has no effect on stricture formation.

Straddle injury:

One of the common causes of urethral stricture is straddle injury to the urethra. This may be an impact injury associated with bleeding per urethra and an inability to urinate. Often patient develop voiding symptoms later (months or years after injury). These strictures are most commonly in bulbar urethra. The bulbar urethra is relatively unprotected, and many boys and young men have some trauma to this area from a bicycle bar, a fence, being kicked, hit by a ball, or any other impact to the scrotal area.

Pelvic bone Fracture Posterior Urethral Disruption Defects (PFUDD):

Common causes of pelvic fractures in men include high speed road traffic accidents and crush injury mostly at work site. When the pelvis is fractured, in some cases there is an associated tear of the membranous urethra leading to complete separation of membranous and prostatic urethra. Patient is unable to pass urine post injury.

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