This document discusses urethral strictures, which are abnormal narrowings of the urethra caused by scarring that replaces the normal tissue. It outlines the main causes of strictures as infections, inflammation, trauma, and rarely congenital abnormalities or cancer. The pathogenesis involves any injury or inflammation that damages the urethral lining, triggering fibrosis and scar formation that narrows the urethral lumen over time. Left untreated, strictures can lead to complications like urinary retention, infections, kidney damage, and rarely fistulas or cancer. The document provides classifications and epidemiological data on urethral strictures.

1. PATHOLOGY OF
URETHRAL
STRICTURES
DR. NWAFULUME OBIORA
UNIVERSITY OF NIGERIA
TEACHING HOSPITAL

2. OUTLINE
• Introduction/ Definition
• Aetiology
• Classification
• Pathology
• Pathophysiology
• Differential diagnoses
• Complications

3. Introduction/Definition
•Urethral stricture is a scarring
process involving the spongy erectile
tissue of the corpus spongiosum.
•It is an abnormal narrowing or loss of
distensibility of the anterior urethra
due to spongiofibrosis at the site of
injury or inflammation.

4. Introduction/Definition
•Urethral strictures are fibrotic
narrowings composed of collagen &
fibroblasts.
•The fibrosis usually extends into the
corpus spongiosum causing
spongiofibrosis.

5. Introduction/Definition
•Posterior urethral stricture is an
obliterative process as result of fibrosis,
and is generally the effect of distraction in
that area caused by either trauma or
radical prostatectomy.

6. AETIOLOGY
• Infective:
• Gonococcal urethritis
• Non-gonococcal
urethritis
• Tuberculous
urethritis
• Schistosomiasis
• Inflammatory:
• Toxic catheter reactions
• BXO
• Traumatic
• External trauma-
straddle injuries,
penetrating injuries
(gunshot, stabs)
• Urethral
instrumentation
• Foreign
body/calculus

7. AETIOLOGY
•Congenital (rare)
•Pin-hole meatus
•Non-meatal strictures
•Neoplastic
• urethral carcinoma

8. CLASSIFICATION
• AETIOLOGY: post-infective, post-traumatic,
neoplastic
• DEGREE OF OBSTRUCTION: complete or
incomplete
• LENGTH OF STRICTURE
• MULTIPLICITY
• SIMPLE or COMPLEX
• ***ANATOMICAL: anterior and posterior

9. EPIDEMIOLOGY
• Predominantly a male disease.
• US and the UK: 1: 10.000 (men aged 25) and
1:1000 (men aged 65 +) by (Andrich and
Mundy).

10. HOSPITAL SERIES
UNITED STATES ABUTH, ZARIA
IDIOPATHIC 34% 8%
IATROGENIC 32% 4%
INFLAMMATORY 20% (BXO/ STD) 75% (STD)
TRAUMATIC 14% 12%
Fenton et al 2005 Maitama et al 2006

11. EPIDEMIOLOGY
• From a study on “urethral stricture analysis and urethroplasty in
UNTH” by Echetabu KN, Ozoemena OFN and Ugwumba FO et
al, 95% of the strictures were posttraumatic.

12. PATHOGENESIS
•Any form of inflammation capable of
causing injury to the lamina propria of
the urothelium is likely to cause
progressive fibrosis of the epithelium
with subsequent involvement of the
underlying corpus spongiosum
(spongiofibrosis).

13. PATHOGENESIS
•The injury with varying location, length
and thickness causes fibrotic scar
formation (replacing the normal
urothelium), narrowing of the urethral
lumen following contraction, and may
culminate in obliteration, and more rarely
fistula formation or abscessation.

14. PATHOGENESIS
•Urethral stricture is formed when the urethra
heals by proliferation of fibroblasts which later
contract.
•Post-inflammatory strictures occur in the
mostly in the bulbous urethra (60·70%) because
its dilatation and angulation.
•Next is the penile urethra and then the glanular
urethra.
•Instrumental injury usually occurs at the bulb.

16. PATHOPHYSIOLOGY
•Urethral dilatation proximal to the
stricture--- diverticular formation---
periurethral abscess
•Urinary fistulae may follow rupture of
periurethral abscesses.

17. PATHOPHYSIOLOGY
• Compensatory changes in the bladder
musculature resulting in
ohypertrophy,
otrabeculation.
oSacculation
odiverticular formation.
• Hypertrophy of the uretero-trigonal complex or
vesicoureteral reflux causing hydroureters and
hydronephrosis,and renal parenchymal atrophy.

18. PATHOPHYSIOLOGY
•Stasis of urine and subsequently---
infections of the urinary tract such as
periurethral abscess, prostatitis, cystitis
and pyelonephritis,
formation of calculi in the urethra or
bladder.
Bladder ca
Hematuria

20. COMPLICATIONS OF STRICTURE
• Retention of urine
• Urethral diverticulum
• Urethral fistula
• Watery can perineum
• Hernia, Haemorrhoids ,and Rectal prolapse
• Urethral or vesical calculi
• Infections- prostatitis, seminal vesiculitis, epididymo-
orchitis
• Obstructive uropathy
• Renal failure

21. DIFFERENTIAL DIAGNOSES
• Benign Prostatic Enlargement
• Carcinoma Prostate
• Carcinoma bladder
• Urethral Carcinoma
• Chronic prostatitis