History

The most common presentation includes obstructive voiding symptoms, urinary retention, or urinary tract infections. Obstructive voiding symptoms are characterized by a decreased force of stream, incomplete emptying of the bladder, urinary terminal dribbling (post-void dribbling), straining to void, and urinary intermittency. These symptoms are progressive in many patients.

Physical Examination

Physical examination in patients with urethral stricture is often normal unless they have involvement of the urethral meatus. This is most commonly seen in men with lichen sclerosus/balanitis xerotica obliterans, in which scarring starts at the urethral meatus and progresses proximally down the urethra. In severe cases, spongiofibrosis of the penile urethra may be palpable on physical exam.

Differential Diagnoses

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Media Gallery

Urethral strictures. Cross-sectional diagram of the penis.
Urethral strictures. Schematic of penile anatomy.
Retrograde urethrogram demonstrating bulbar urethral stricture.
Urethral strictures. Retrograde urethrogram demonstrating complete obliteration of the bulbous urethra.
Retrograde urethrogram demonstrating pan-urethral stricture disease.
Urethral strictures. Retrograde urethrogram demonstrating patent urethra after buccal mucosa urethroplasty.
Urethral strictures. Retrograde urethrogram demonstrating patent urethra after excision of stricture and primary anastomosis.
Urethral strictures. Photograph of a permanent urethral stent.
Urethral strictures. A buccal mouth graft has been harvested from the inner aspect of the cheek. The graft size is measured to accommodate the length of urethra involved in the onlay.
Urethral strictures. The buccal mucosal grafts have been secured to the corpora cavernosa. The anastomosis will run along either side of the dorsum of the urethral edges to complete the dorsal onlay. The glans penis (distal) is at the top of the picture. The catheterized urethra with a dorsal urethrotomy is on the left.
Urethral strictures. Photograph of open urethroplasty depicting the pedicled flap.
Urethral strictures. Photograph depicting pedicled flap anastomosed to the left side of the urethra. Suturing of the right side of the pedicled flap to the urethra completes the anastomosis.
Urethral strictures. The anastomosis of the pedicled flap is complete. The pedicle of the flap (left side) originates from the dorsolateral aspect of the penis. The glans penis (distal) is at the top of the photograph.

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Author

Wesley R Baas, MD Assistant Professor of Clinical Surgery (Urology), University of Cincinnati College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoscopic and Robotic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

Additional Contributors

Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American Urological Association

Disclosure: Nothing to disclose.

Richard A Santucci, MD, FACS Senior Surgeon, Crane Surgical Services

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, International Society of Urology

Disclosure: Nothing to disclose.

Joshua A Broghammer, MD, FACS Associate Professor, Department of Urology, Trauma and Genitourinary Reconstructive Surgery, University of Kansas Medical Center

Joshua A Broghammer, MD, FACS is a member of the following medical societies: American Association of Clinical Urologists, American College of Surgeons, American Urological Association, Society of Genitourinary Reconstructive Surgeons

Disclosure: Received consulting fee from American Medical Systems for consulting.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Jon Timothy Posey, MD; Angelo E Gousse, MD; and Daniel J Caruso, MD, MBA to the original writing and development of this article.

Urethral Strictures in Males Clinical Presentation

History

Physical Examination

References

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