Stenosis or Narrowing of the Urethra

What is urethral stricture or urethral narrowing?

In women, the urethra is very short (between 4 and 5 cm) and does not usually cause stricture problems. However, in the male this duct is longer and therefore it is more common for these strictures to appear, which can be of greater or lesser length and of greater or lesser thickness and severity.

Anatomy and parts of the urethra in man:

These are the parts of the urethra from the outside (glans) to the inside (prostatic area, closer to the bladder):

Anterior Urethra

It is the one that sits in the penile area and measures between 22 and 25 cm in length:

• Glandular or navicular urethra:the area of the urethra located on the glans penis.
• Penile or pendulous urethra: It is the part that covers almost the entire penis, from the penoscrotal angle to the urethral meatus (tip of the penis). On its dorsal side are the Littré glands, responsible for generating the mucous that protects and lubricates the walls of the urethra and which are also incorporated into the semen.
•  Bulbar Urethra:it is a wide and distensible area of the urethra. It extends from the urogenital diaphragm to the penoscrotal angle. The ducts of the bulbourethral glands or Cowper's glands, two glands that secrete a fluid that lubricates the urethra prior to ejaculation, flow into its ventral area.

Posterior Urethra

It has a length of 5 cm and is formed by:

• Prostatic urethra: during urination, urine passes through the neck of the bladder into another section surrounded by the prostate, called the prostatic urethra.
• Membranous urethra: the segment following the prostatic urethra is the membranous urethra, which contains a muscle called the external urinary sphincter, responsible for voluntarily holding urine and stopping urination (cutting off the urine stream).

The treatment of urethral stricture will vary depending on the anatomical location, length, severity and previous surgeries performed on the patient. The different types of urethral strictures are:

• Penile urethral stricture: approximately half of the urethral strictures are anterior, especially affecting the end of the duct, the urethral meatus -the urinary orifice-.
• Bulbar urethral stricture.
• Membranous urethral stricture: as it appears close to the urinary sphincter and the prostate, the situation is more delicate, both because of the surgical access and the possibility of incontinence with surgery.

It usually requires multiple interventions and follow-up throughout life, since urethral stricture does not heal on its own.

When urethral stricture occurs, the bladder attempts to compensate for the obstruction by hypertrophy (increased muscle mass and strength) of the detrusor (smooth muscle that forms part of the urinary bladder wall and whose contraction causes urination), generating more pressure in the bladder. Sometimes this may be sufficient to continue urinating at least in the early stages or in mild urethral strictures. As the obstruction increases, the bladder will no longer be able to compensate for this obstacle and will begin to retain urine, which may lead to other problems such as acute urinary retention, bladder diverticula, hydronephrosis, renal failure or stones in the bladder, kidney or ureter.

The treatment of urethral stricture requires very specialized teams in the management of this disease to obtain good results and prevent the problem from recurring in the future. ROC Clinic is recognized as one of the best centers in the treatment of urethral stricture.