Urethral Stricture

  • Medical Author: Pamela I. Ellsworth, MD
  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

How do physicians diagnose urethral strictures?

The diagnosis is made based on history, physical examination, and one or more studies to determine the location and extent of the stricture.

When the medical history, physical examination, and symptoms are suggestive of urethral stricture, additional diagnostic tests may be helpful in further evaluation. Urinalysis (UA), urine culture, and urethral culture for sexually transmitted diseases (gonorrhea, chlamydia) are some of the typical tests that may be ordered in this setting. Examination of the prostate and screening for prostate cancer (manual exam and measurement of prostate specific antigen or PSA) may also be done by the doctor.

Oftentimes, imaging and endoscopic studies are necessary to confirm the diagnosis and identify the location, length, and extent of the narrowing from the stricture.

Are there any special tests for diagnosing urethral strictures?

The following are some common imaging and endoscopic tests in evaluating urethral stricture:

  • Ultrasound of the urethra
  • Retrograde urethrogram
  • Cystography, filling and voiding (VCUG)
  • Anterograde cystourethrogram
  • Cystourethroscopy
  • MRI and CT scan

Ultrasound of the urethra is one of the radiologic methods in evaluating urethral stricture. An ultrasound probe can be placed along the length of the penis (phallus) and determine the size of the stricture, degree of narrowing, and length of the stricture. This is a noninvasive method and usually does not require any special preparation. However, ultrasound of the urethra is limited by the location of the stricture. Ultrasound of the urethra is more helpful in identifying strictures in the part of the urethra that passes through the penis. Currently, ultrasound of the urethra may be used in addition to other studies, such as retrograde urethrogram (RUG) to define the stricture before surgery.

Retrograde urethrogram is another radiology test to evaluate urethral strictures. This test basically entails placing a small urinary catheter in the last part of the urethra, the urethral meatus (the opening at the tip of the penis). The balloon of the catheter is gently inflated to hold the catheter in place during the study. A small amount (10-20 cc) of an iodine contrast material is slowly injected in the urethra via the catheter. Then, radiographic pictures are taken under fluoroscopy to assess any obstruction or impairment to the flow of the contrast material that can suggest urethral stricture. This test provides useful information about the location, length of the stricture, and presence of other abnormalities.

Cystography, filling and voiding (VCUG) is helpful to look at the first part of the urethra, proximal urethra. In this study, the bladder is filled and the individual voids under fluoroscopy.

Antegrade cystourethrogram is a similar test but can only be done if there is a suprapubic catheter in place (a urinary catheter placed in the bladder through the skin in the lower abdomen). Iodine contrast is then injected into the bladder via the catheter and its flow out of the urethra is radiographed under fluoroscopy.

Cystourethroscopy is an endoscopic evaluation in which a small instrument that is a thin tube with a camera at the tip is inserted into the urethra to look directly at the inside (lumen) of the urethra. The tip of the urethral opening is cleansed to prevent infection, and local lubricant and anesthetic gels are applied for comfort. Then the endoscope is inserted into the urethra and bladder. Any anatomical or structural abnormalities will be detected, and a biopsy can be obtained at the same time if necessary. Cystoscopy is limited as the length of the stricture and the exact location may not be able to be fully identified due to the size of the scope and the degree of narrowing of the urethra. In individuals with a suprapubic tube in place, the cystoscopy can be performed with a flexible tube through the suprapubic tract, termed antegrade cystoscopy.

MRI and CT: These studies are used less frequently to evaluate urethral strictures but in certain cases may be helpful, such as in individuals with a history of a fracture of the pelvic bone(s).

Medically Reviewed by a Doctor on 10/29/2016

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