What are causes of a urethral stricture?
It depends on whether the stricture is anterior or posterior. Causes of an anterior stricture include instrumentation, sexually transmitted disease, and crush/straddle injuries. Causes of a posterior stricture include instrumentation, pelvic fracture (membranous urethra), and radiation therapy for prostate cancer (EBRT, brachytherapy).
How can urethral strictures be treated?
Options include balloon urethra dilation (especially for short strictures), endoscopic urethrotomy, and urethra stenting (associated with multiple complications)
Why is localizing a stricture accurately in either the penile or bulbar segment of use to the urologist?
The two segments have different outcomes after therapy. The penile urethra has an increased risk of stricture recurrence post therapy, compared with the bulbar urethra.
Scout image: Multiple clips from a radical prostatectomy.
Retrograde urethrogram (RUG):
There is a 1.4 cm narrowing in the bulbar urethra (to approximately 4 mm), which did not relax on subsequent views. No leak. When turned to the left oblique position, the penis could not be straightened out fully and the length of the stricture is foreshortened.
The penile urethra is normal.
Voiding cystourethrogram (VCUG):
The posterior urethra is normal. No leak or stricture. The vesicourethral junction and anastomosis funnels normally during voiding. No post void residual. The bulbar urethra stricture can be seen, but is not as well evaluated as on the retrograde/ascending urethrogram.