Male urethral stenosis Tightening of the urethra

Male urethral stenosis consists of a decrease in the lumen of the urethra in any of its segments, from the bladder neck to the urethral meatus.

Stenosis of the urethra commonly occurs as a response to any aggression to the urethral mucosa, with associated fibrosis and scarring, which may partially or totally obstruct the lumen of the urethra. Most of the cases are associated with diagnostic and therapeutic instrumentation of the urinary tract or with long-term or recurrent catheterization. There are also cases associated with perineal trauma or long-term infections of the urethra (urethritis) left untreated. However, there are many cases in which it is not possible to associate any etiological factor with the development of the stenosis, being thus considered to be of idiopathic origin.

Patients resort to urology consultation mainly with complaints of voiding difficulty, decreased urinary jet caliber and the feeling of incomplete voiding. Long-term strictures can also lead to increased urinary frequency and urinary urgency, sometimes with associated urinary incontinence. They can also be a trigger for recurrent urinary infections.

The diagnosis of this pathology is based on the clinical history and the performance of complementary diagnostic tests that allow the identification of stenosis, its location and its extension, with emphasis on Urethrocystoscopy and Retrograde and Permictional Urethrography.

In a large percentage of cases, treatment is surgical.

There is the possibility of non-surgical treatment by performing dilatation of the urethra in small stenoses, but with low success rates and high recurrence rates.

Regarding surgical treatment, there is the possibility of carrying it out by transurethral endoscopy, called Internal urethrotomy, but it also presents low success rates and high recurrence rates, being indicated only for the treatment of small stenoses. The gold-standard treatment is called urethroplasty and consists of surgical repair of the urethra, with or without recourse to grafts (preferably from the oral mucosa) and flaps (foreskin or penile skin)