The document discusses urethral stricture, a condition characterized by the narrowing of the urethral lumen, commonly due to scarring from various causes such as infections, trauma, and surgeries. It outlines the anatomy and physiology of both male and female urethras, the epidemiology of the condition, symptoms, clinical diagnosis methods, and management strategies. Key treatments include catheterization, dilation, and urethroplasty, while early detection and addressing underlying causes are emphasized for prevention.

1. URETHRAL STRICTURE
BY Athanase YAMFASHIJE

2. INTRODUCTION
The urethra is the tubular structure lined by stratified columnar
epithelium that convey urine from the bladder to an external opening in
the perineum as its primary role in both male and female
It also play an important role in ejaculation for men
 It is lined by mucous secreting glands that act as protection from
corrosive urine contents
Urethral strictures is the narrowing of urethral lumen that is mostly due
to the scaring

3. SCOPE
 Normal anatomy and physiology
 Epidemiology
 Etiology/Causes of urethral stricture
 Types of urethral stricture
 Symptoms and Signs
 Clinical diagnosis
 Management
 Prevention

4. NORMAL ANATOMY AND PHYSIOLOGY

5. MALE URETHRA
The male urethra is approximately 15-20cm long. In addition to
urine, the male urethra transports semen
Anatomically, male urethra is made of three parts(from
proximal to distal)
 Prostatic urethra
 Membranous urethra
 Bulbous/Penile urethra

6. Prostatic,Membranous, Penile urethra are supplied by the
inferior vesical artery (branch of the internal iliac artery),
bulbourethral artery (branch of the internal pudendal artery) and
direct branches of the internal pudendal artery respectively
The nerve supply to the male urethra is derived from the
prostatic plexus, which contains a mixture of sympathetic,
parasympathetic and visceral afferent fibres
The prostatic and membranous portions drain to the obturator
and internal iliac nodes, while the penile urethra drains to the
deep and superficial inguinal nodes

8. FEMALE URETHRA
 Short urethra (approximately 4cm)
It begins at the neck of the bladder, and passes inferiorly
through the perineal membrane and muscular pelvic floor
The urethra opens directly onto the perineum, in an area
between the labia minora, known as the vestibule.
 The urethral orifice is located anteriorly to the vaginal opening,
and 2-3cm posteriorly to the clitoris

9. The distal end of the urethra is marked by the presence
Skene’s glands(correspondant of prostate in male) on either
side of the urethra
The blood supply is via the internal pudendal ertery/vein,
vaginal arteries/veins and inferior vesical branches of the
vaginal arteries/veins
The nerve supply is from the vesical plexus and the pudendal
nerve.Visceral afferents from the urethra run in the pelvic
splanchnic nerves
The proximal and distal female urethra drains into the internal
iliac nodes and superficial inguinal lymph nodes respectively

11. EPIDEMIOLOGY
 0.6% of the population are at risk
 Common in the elder of over 55 years old
 Males are affected than females

12. ETIOLOGY/CAUSES
The narrowing of urethra is secondary to the scaring as resul of:
Infections(urethritis and STDs)
inflammatory Processes(like enlarged Prostate)
Post-traumat(endoscopy, intermittent or long-term use of
catheter, injury to bladder or pelvis)
 Post prostate cancer treatment or surgical operation like
circumcision
 Lichen sclerosis

13. Anterior urethra(most common) affect spongy ption of
urethra and is secondary to scarring in the spongy erectile
tissue of the corpus spongiosum
Posterior which affect proximal portion(one to two inches)
and is due to a fibrotic process that narrows the bladder neck
and usually results from a distraction injury secondary to
trauma or surgery, such as radical prostatectomy
TYPES OF URETHRAL STRICTURE

15. SYMPTOMS AND SIGNS
 bloody or dark urine/ blood in semen
 Abdominal pain
Decreased urine stream
Incomplete bladder empting
Spraying of the urine stream
Difficulty, staining, or pain when urinating
Increased urge to urinate or more frequent urination
 swelling of the penis, urethral leaking and UTIs in men
loss of bladder control

16. CLINICAL DIAGNOSIS
Urinalysis
Urinary flow test
Urethral ultrasound to evaluate the length of the stricture
Pelvic ultrasound to look PVR
Pelvic magnetic resonance imaging (MRI) to assess whether
your pelvic bone is affecting or is affected by your condition

17. Retrograde urethrogram: uses X-ray images to check for a structural
problem or injury of the urethra as well as the length and location of
the stricture along the urethra
Cystoscopy examines your urethra and bladder using a thin, tubelike
device fitted with a lens (cystoscope) to view these organs
Perform biopsy for suspected lichen sclerosus (LS), or if urethral
cancer is suspected

18. MANAGEMENT
Catheterization
 Dilation
Urethroplasty
Endoscopic urethrotomy
Implanted stent or permanent catheter
Treat the underlying cause especially the infection

20. REFERENCE
Netter’s atlas of Human Anatomy, 6th ed
Urology-handbook for medical students, 1E 2001
Urology reference guide
https://emedicine.medscape.com/article/450903-overview
https://emedicine.medscape.com/article/450903-overview