Diagnosing Urethral Stricture

A urethral stricture is a narrowing of the urethra, the tube that carries urine out of the body. It is caused by a build up of scar tissue or inflammation around the urethra and is more common in men than in women. 

There are several causes of urethral stricture, including a prior surgery, catheter placement, infection resulting from a sexually transmitted disease (STD), and, in men, trauma to the penis or perineum, which is the pelvic floor area behind the scrotum. This includes “straddle injury,” in which trauma to the groin occurs when a person falls onto an object, such as the crossbar on a bicycle. Radiation therapy for prostate cancer or other types of cancer can also lead to a stricture.

Some people with urethral stricture notice no symptoms. In others, problems with urination may be the first sign that something is wrong. You may experience pain during urination, have a slower than usual stream of urine, be unable to completely empty your bladder, or notice extra drips of urine after you finish urinating. 

If left untreated, a urethral stricture can cause serious problems, including bladder and kidney damage, infections caused by the obstruction of urine flow, and poor ejaculation and infertility in men. Fortunately, strictures can be successfully treated. 

Diagnostic Tests for a Urethral Stricture

If you are experiencing urination problems, your doctor may ask about your medical history, perform a physical exam, and analyze a urine sample before ordering additional tests to determine the cause of your symptoms. At NYU Langone, our diagnostic tests for urethral stricture include:

Uroflow

During the uroflow screening test, a funnel-shaped collection device is used to measure the force of your urinary stream. The flow rate helps doctors determine whether there may be a blockage due to a stricture. 

Postvoid Residual Testing

Urethral stricture can prevent urine from leaving the bladder, which can lead to infection. In a postvoid residual test, ultrasound imaging of the bladder is performed immediately after urination. During an ultrasound scan, sound waves are used to create an image that allows your doctors to measure any remaining urine. 

Cystoscopy

A cystoscopy procedure allows doctors to view the urethra to see if strictures are present. A doctor guides a narrow, flexible scope into the urethra and uses ultrasound to determine the location and length of strictures. This procedure is performed in the doctor’s office.

Retrograde Urethrogram

After a stricture is diagnosed, the length and degree of narrowing can be evaluated with a retrograde urethrogram. This is an important step toward planning treatment, because the length of the stricture affects the types and success of treatment. In this diagnostic test, iodine contrast is inserted into the urethra while images are created using X-ray or ultrasound.