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Male urethral stricture
Anterior urethral stricture results from scarring of the corpus spongiosum; a short first bulbar stricture may get one trial of urethrotomy or dilation, but a recurrent, long or penile stricture is treated with urethroplasty.
Why it matters in the exam
The exam shows a man with a weak, spraying stream, incomplete emptying, recurrent infections or retention, sometimes after catheterisation, TURP or a "straddle" injury to the perineum. Questions deal with diagnosis, choice of treatment and the common complication of internal urethrotomy — recurrence of the stricture. Long-term success of urethrotomy is low, and repeat urethrotomy is almost useless; the AUA guideline recommends urethroplasty after failure of endoscopic treatment.
Causes: idiopathic, iatrogenic (catheter, TURP, cystoscopy), trauma (straddle injury to the bulbar urethra), lichen sclerosus (in the penile urethra and meatus — the leading cause of meatal stenosis in adults) and infection. Flowmetry shows a flat, prolonged ("plateau") curve. Diagnosis: retrograde urethrography together with voiding cystourethrography to measure length and site, and urethroscopy. A "posterior" stricture after pelvic fracture is really a gap between the urethral ends (PFUI) and is repaired by direct anastomosis.
Treatment by length and site: a short bulbar stricture (up to 2 to 3 cm) — excision and primary anastomosis (EPA) with high success; a longer stricture — urethroplasty with a buccal mucosa graft. A penile stricture or one from lichen sclerosus — not suited to urethrotomy; a two-stage repair is sometimes needed. In an older patient or one with many illnesses, self-dilation or a perineal urethrostomy is possible. A bladder neck contracture after prostatectomy is treated by endoscopic incision or dilation. After any treatment, follow-up is by flowmetry and residual volume, and recurrent symptoms require urethroscopy.
Key points
- Flat flow curve — stricture.
- Diagnosis by retrograde and voiding urethrography.
- One endoscopic attempt only.
- EPA for a short stricture; buccal graft for a long one.
- Lichen sclerosus — the leading cause of meatal stenosis.
Summary table
| Situation | Preferred treatment | Note |
|---|---|---|
| First short bulbar stricture | Urethrotomy or dilation | One trial only |
| Recurrent short bulbar stricture | Excision and primary anastomosis (EPA) | Up to 2 to 3 cm |
| Long bulbar stricture | Urethroplasty with buccal graft | High success |
| Penile stricture or lichen sclerosus | Urethroplasty, sometimes in two stages | Not urethrotomy |
| Gap after pelvic fracture | Delayed direct anastomosis | After 3 months |
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Sources
- AUA Guideline: Urethral Stricture, 2016, amended 2023 — Diagnosis and management of male urethral stricture
- EAU Guidelines on Urethral Strictures, 2025 edition — Anterior and posterior urethral stricture
- Campbell-Walsh-Wein Urology, 12th edition (2020) — Surgery of the Penis and Urethra
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.