Congenital Urethral Stricture

What Is a Congenital Urethral Stricture?

The thin tube that carries the urine from the urinary bladder to the outside of the body is the urethra. The problem arises when this tube becomes narrow and causes difficulty in urinating, resulting in a condition known as urethral stricture. It might be present by birth or acquired by an individual during their lifetime. The condition is known as congenital urethral stricture when the urethra is narrow congenitally or by birth. Males are most likely to encounter this condition. They experience discomfort while passing urine and tend to have a slow urine stream. Sometimes, the condition develops gradually, making it difficult for the patient to push the urine out. The condition might occur suddenly if it is not present by birth.

What Are the Causes of Congenital Urethral Stricture?

Urethral stricture mainly involves urethral constriction due to inflammation of the tissues and the formation of scar tissues. A congenital urethral stricture mainly occurs due to the incomplete fusion of the anterior and posterior urethra. It is not associated with any inflammatory process and mainly occurs due to a rare cause. In addition to the inadequate fusion, young males who have undergone hypospadias surgery (a surgery done to repair an underdeveloped urethra) and males who have penile implants are at a higher risk of developing urethral stricture. One of the most common types of injury that can cause urethral stricture is straddle injury. The possible causes of urethral stricture are listed below:

1. Fracture in the pelvis.

2. Insertion of the catheter.

3. Radiation.

4. Prostate surgery.

5. Benign prostate hyperplasia.

6. Tumors located close to the urethra.

7. Recurrent urinary tract infections.

What Are the Different Types of Urethral Strictures?

Urethral stricture can be anterior or posterior. Both of them have been described below:

1) Anterior Urethral Stricture - Anterior urethral strictures usually occur in the last 9 to 10 inches of the urethra. It is mainly caused by:

• Trauma due to straddle injury.

• Penis injury.

• Catheterization.

2) Posterior Urethral Stricture - Posterior urethral stricture usually occurs in the last one to two inches of the urethra. It mainly occurs due to an injury in the pelvis, including a pelvic fracture. In such a situation, the urethra is completely cut or disrupted and does not allow the passage of urine. Hence, a thin, flexible tube called a catheter is placed into the urinary bladder through the abdomen to facilitate urine drainage.

What Are the Signs and Symptoms of Congenital Urethral Stricture?

There can be numerous signs and symptoms of urethral stricture, ranging from mild to severe. Some of the signs and symptoms of urethral stricture are listed below:

• Difficulty in starting the urine stream.

• The urinary bladder does not become empty.

• Pain or difficulty in passing urine.

• A strong urge to urinate frequently.

• Urinary tract infections.

• Abdominal pain.

• Swelling of the penis.

• Loss of bladder control.

What Tests Are Done to Diagnose Congenital Urethral Stricture?

Several imaging and laboratory tests are done to diagnose congenital urethral stricture. The diagnostic methods have been described below:

• Physical Examination - Though congenital urethral stricture cannot be diagnosed by physical examination, the doctor might examine the patient thoroughly to detect other signs and symptoms.

• Uroflow - The child is asked to urinate in a special toilet known as the uroflow chair. This test helps measure the urine flow rate and the time required to empty the bladder. After the child has completed urinating, the test also checks the amount of urine left in the bladder with the help of a special ultrasound known as the bladder scan. Children suffering from urethral stricture usually present with a reduced urinary flow and take a long time to empty the bladder.

• Kidney, Ureter, and Bladder Ultrasound - It is a simple procedure that can be safely performed in children using sound waves instead of X-rays. The child is asked to lie down on a table. The doctor moves a transducer over the abdomen to obtain the images on the computer screen. This test helps the doctor visualize the kidneys, ureters, and bladder.

• Retrograde Urethrogram - This procedure mainly calculates the number of strictures, their length, position, and severity. It is an outpatient procedure wherein a tube known as the catheter is inserted into the child’s urethra to reach the urinary bladder. An opaque solution is injected into the body through the catheter. As the opaque solution fills the bladder, the doctor obtains the images with the help of a special X-ray machine known as fluoroscopy. This test is effective in diagnosing urethral stricture as it allows the radiologist to see the narrowing of the urethra. It also explains the degree of urethral narrowing and if any other malformations are present.

How Is a Congenital Urethral Stricture Treated?

The following surgical treatments are usually followed to treat congenital urethral stricture:

1. Cystoscopy - It is a simple surgical procedure wherein a tube known as a cystoscope is inserted into the urethra to reach the urinary bladder. It helps in diagnosing and treating congenital urethral stricture simultaneously. The device has a camera at one end and a light at the other to visualize the operation site.

2. Endoscopic Urethrotomy - This procedure is similar to cystoscopy. General anesthesia is administered to the patient before the insertion of a cystoscope. After the stricture becomes visible, the stricture is cut lengthwise with the help of a blade. So, this procedure helps widen the urethra and allows the passage of urine. A tube or a catheter is left at the site for a few days after the process is complete.

3. Urethroplasty - Urethroplasty is a complex procedure that is done for longer strictures. This procedure involves an incision between the rectum and the scrotum. The narrowed part of the urethra is removed while the remaining part is reconstructed, known as anastomosis. If the stricture is lengthy, a tissue graft is usually taken from the mouth to increase the length of the urethra. As urethroplasty is a complex procedure, the doctor might recommend that urethroplasty is done in a staged manner. It means that more than one surgery might be done.

Conclusion:

Congenital urethral stricture is characterized by difficulties in passing urine due to the narrowing of the urethra. However, the patient must not worry as the condition is not incurable. Surgical procedures are available to cure the condition and widen the urethra. Therefore, the patient suffering from this condition must consult a urologist at the earliest to learn more about the management and prevention.