Urology Division, Department of Surgery

Faculty Of Medicine
University Of Sumatera Utara

Urethral Stricture
Learning Objective
• Mampu menjelaskan etiologi
• Mampu mendiagnosa secara klinik berdasarkan anamnese,
pemeriksaan fisik, laboratorium dan Radiologi
• Mampu menjelaskan penatalaksanaan
• Mampu merujuk ke spesialis
Standar Kompetensi Dokter Indonesia
(SKDI)
Tingkat
No Topik Tingkat Kemampuan
Kompetensi
• Mendiagnosis
1 Striktur Urethra 2
• Merujuk

Lulusan dokter mampu :

• Membuat diagnosis klinik terhadap penyakit tersebut
• Menentukan rujukan yang paling tepat bagi penanganan pasien selanjutnya
• Menindaklanjuti sesudah kembali dari rujukan
Definition
• A Urethral stricture is a fibrotic tissue that renders the normally
compliant urethral lumen inelastic.
• The term urethral stricture refers to anterior urethral disease, or a
scarring process involving the spongy erectile tissue of the corpus
spongiosum (spongiofibrosis)

1. Metro MJ. Urethral Stricture Disease. In :Penn’s Clinical Manual Of Urology

2. Jordan GH, et al. Surgery of the Penis and Urethra. In: Campbell-Walsh 10 th Edition
Epidemiology
• Bulbar stricture are the most common (50%)
• Penile stricture (30%)
• Stricture of navicular fossa (20%)
• Stricture in posterior urethra are rare

1. Tritschler S,et al. Dtsch Arztebl Int 2013; 110(13): 220–6

 Anatomy of Urethra
• Originates at the bladder neck
and terminates at the urethral
meatus on the glans penis.
• Roughly 15-25 cm long in the
adult and forms an "S" curve
• Consist of 4 parts :
• 1. Penile Urethra
• 2. Bulbar Urethra
• 3. Membranous Urethra
• 4. Prostatic Urethra
Etiologies
• Congenital stricture
• Rare
• Common sites : fossa naviculare and membranous urethra.

• Acquired strictures
• Trauma : anterior urethra, posterior
urethra
• Iatrogenic : traumatic catheterization,
instrumentation, TUR-P, Radical
Prostatectomy, Hypospadias correction,
cystoscopy
• Infection : gonococcal urethritis,
Chlamydia, STDs
Pathophysiology of Urethral Stricture
Urethral lumen Urethral lumen
Trauma / Infection
narrowing blockage

Epithelial urethral
Fibrotic tissue Urinary retention
lesion

Inflammatory
Urethral mucosa responses with
disruption cytokines and
mediators
Pathology of Urethral Stricture
A. Mucosal fold
B. Iris constriction
C. Minimal fibrosis
D. Spongiofibrosis
E. Fibrosis and
inflammaton to
corpus
spongiosum
F. Stricture with
fistula
Clinical Presentation
Obstruction
• Slowing of urinary stream
• Decreased caliber of the stream
• Increase in voiding time
• Incomplete bladder emptying
• Post-void dribble
Infection
• Prostatitis
• Epidydimo-orchitis
• UTI
Acute Urinary retention
Diagnosis : Examination (Physical)
Inspection
Narrow urethral meatus
Swollen penis
Fistula to penis, scrotum, perineum and suprapubic
Palpation
Palpable fibrotic tissue along anterior urethra on ventral penis
Urethral discharge (eg. pus) might be found with history of gonococcal
infection
Diagnosis : Examination (RUG)
Retrograde Urethrography
Gold standard for diagnosis
Ideally be performed (or directly supervised) and interpreted by the
treating urologist
Need proper position
Performed to diagnosed location and length of urethral stricture
Position
Normal Urethrography
Stricture on Urethrogaphy

Tritschler S,et al. Dtsch Arztebl Int 2013; 110(13): 220–6

Treatment
Emergency Treatment : Acute Urinary Retention
• AUR is urological emergency, commonly found in patient with
urethral stricture
• If AUR is present, and foley catheter is unable to pass the defect site
• Perform cystostomy or suprapubic puncture
• After AUR released, immediately refer patient to urologist
Definitive Treatment
Dilation
• Inserting devices to enlarge the stricture with gradual stretching
• Recommended as an initial step
• Least invasive, effective for both males and females.
Urethrotomy
• Surgically cutting the stricture with a special laser or scalpel with urethroscopic guidance.
Open surgical removal
• Most invasive approach to correcting urethral strictures.
• Surgically removed, and potentially using grafts or other reconstructive procedures on the
urethra.
Thank You