What Is a Urethral Stricture?

The urethra is the tube that carries urine from the bladder out of the body. A stricture is a segment where scarring has narrowed this tube. Causes include infection, injury (including straddle injuries), catheterisation, previous surgery or instrumentation — and sometimes no clear cause is found.

The typical story is a slowly worsening weak or spraying stream, needing to strain, a feeling of incomplete emptying, and sometimes recurrent infections. Because the symptoms overlap with prostate enlargement, strictures are occasionally missed — a clue is that prostate medicines do not help.

Diagnosis uses a urine flow test, ultrasound (including residual urine), and imaging of the urethra itself — a retrograde urethrogram, an X-ray taken while dye outlines the passage — sometimes combined with a look inside (cystoscopy). These define the stricture's length and position, which determine treatment.

Short, first-time strictures may be managed with dilatation or an internal incision (DVIU). Recurrent or longer strictures are best treated with urethroplasty — reconstructive surgery that offers substantially more durable results than repeated stretching. The key message: repeated dilatations with diminishing returns are a signal to discuss definitive reconstruction rather than more of the same.