Screening and Diagnosis
- Injury – this is the most common cause of strictures. An injury occurs when the penis or pelvic area is damaged from an accident or other situation. In fact, nearly all posterior urethral strictures are caused by pelvic fractures, which can happen in car accidents or industrial accidents. Anterior urethral strictures may be caused by a “straddle injury” such as falling on a plank or bicycle handlebars.
- Instruments – sometimes when placing a catheter into the bladder, damage may be caused which causes scar tissue. Although it is not common, damage may also be caused during surgery on the prostate, bladder or kidneys.
- Infection – infections like gonorrhea or Chlamydia may cause strictures.
- Lichen sclerosis – (also called “balanitis xerotica obliterans” or “BXO”) This is an illness which causes inflammation. It is becoming a more common condition. BXO causes strictures that are some of the most difficult to treat. It can cause swelling and scarring.
The cause of BXO is unknown. It can occur in men or women. In men, it causes the skin on the penis to whiten, and become tight. If caught early enough it can be managed with ointment spread on the skin. Patients with later stage BXO often need surgery. Additional information on BXO is available on an online support group at www.ls-bxo.org.
- Prostate cancer therapy – prostate cancer treatments can sometimes cause incontinence (urine leakage) and stricture. Stricture can occur by the stitches used in a radical prostatectomy, or by scar tissue anywhere along the urethra after radiation, brachytherapy or cryotherapy.
- 6. Unknown – sometimes it is unclear what caused the urethral stricture. Fortunately, this does not affect the success of treatment.
- Cystoscopy (see figure) – strictures are most commonly identified with a small flexible camera (called a “cystoscope”) passed through the penis towards the bladder.
- Urethrogram (see figures) – a cystoscope often can’t pass through the stricture, which makes it impossible to see the length of the stricture. The next step is a test called a urethrogram. A patient is awake during this test. First, the doctor puts liquid dye into the penis as far as it will go. The dye will show on X-ray pictures. Next, a small, flexible catheter is gently inserted through the stricture into the bladder. The bladder is then filled with the same dye. The catheter is removed and the patient urinates into a urinal while more X-ray pictures are taken.
- Uroflowmetry – the patient urinates into a small machine that measures how fast the urine comes out and the force of the stream.
- Post-void residual urine volume – After a patient urinates, a nurse ultrasounds the patient’s abdomen to see how much urine is still in the bladder.
- Urinalysis and culture – a urine sample may be collected to look for blood or infection.
- Sonourethrogram (see figure) – Also known as a urethral ultrasound. This is done when the patient is asleep during the reconstructive surgery. It is very accurate at measuring the length of stricture.