Urethral Stricture
Urethral stricture is scarring that narrows the urethra and obstructs urine flow, evaluated and treated per the AUA 2023 Urethral Stricture Disease Guideline.
Symptoms
Weak or split urine stream, straining to urinate, incomplete emptying, and sometimes recurrent UTIs from the obstruction.
Causes and risk
Prior catheterization or urologic instrumentation is the most common identifiable cause in the U.S.; trauma, prior STIs, and scarring from other procedures also contribute.
How it is evaluated
Uroflowmetry screens for obstruction; a retrograde urethrogram is the study of choice for mapping the stricture's length and location before treatment planning.
Treatment
Options range from dilation and endoscopic urethrotomy (better for short strictures) to urethroplasty (reconstructive surgery), which the guideline favors for recurrent strictures rather than repeating endoscopic procedures indefinitely, since repeat endoscopic treatment has diminishing returns.
When to seek care
Complete inability to urinate is a urologic emergency needing prompt bladder drainage, whether by catheter or, when that's not possible, a suprapubic tube -- this cannot be managed by telehealth alone.