Urethral stricture is a significant urological problem that makes urination difficult in men, severely impairs quality of life, and—if left untreated—can progress to kidney failure. My patients typically present with the following symptoms:

•“Doctor, my urinary flow rate has dropped significantly.”

•“My urine comes out like a thin string.”

•“I get urinary tract infections often.”

•“I experience a burning sensation and difficulty when urinating.”

•“It’s as if the urine can’t find a way out.”

These symptoms are often the first signs of urethral stricture.

In this article, I will explain in great detail all the critical aspects—such as what urethral stricture is, what causes it, how it is diagnosed, what treatments are available, and which surgical procedures are most successful—based on my clinical experience and the latest scientific data in modern urology.

If you're ready, let's get started.

The urethra is the tube through which urine is expelled from the bladder.

In men, the urethra is approximately 18–22 cm long and consists of the following sections:

1. Posterior urethra (back of the urethra)

2. Anterior urethra (front urethra)

3. Penile urethra

4. Glandular urethra (inside the glans penis)

A narrowing may occur in any section of this channel.

Because the urethra is shorter in women, strictures are very rare.

In men, however, we see this frequently due to their anatomical structure.

Urethral stricture is a narrowing or complete obstruction of the lumen caused by scar tissue forming on the inner wall of the urethra. This tissue:

•Trauma

•Infection

•Surgical procedure

•Inflammation

As a result, the channel gradually narrows.

Conclusion:

Urination becomes difficult → pressure increases → the bladder is damaged → in advanced stages, the kidneys may be affected.

Urethral stricture is definitely not a “temporary problem”; any stricture that goes untreated tends to progress.

The primary cause of the narrowing is the formation of scar tissue inside the urethra.

The most common causes of this condition are:

In particular:

•Bicycle accidents

•Motorcycle accidents

•Sports injuries

•Blows to the groin

•Pelvic fractures

It is the most common cause of urethral stricture worldwide.

⸻

Long-term catheter use or traumatic catheter insertion can damage the urethra.

Also:

•TUR-P

•Prostate biopsies

•Urethral surgeries

•Hypospadias surgeries

Narrow-mindedness may also develop afterward.

Sexually transmitted infections such as gonorrhea or chlamydia cause severe scarring in the urethra.

This skin condition affects the skin of the penis and the urethra.

If it progresses, it causes long-segment stenosis.

It is a rare occurrence.

Approximately 30% of all narrowings occur for no apparent reason.

Urethral stricture usually progresses insidiously.

Patients may not notice it at first, but the severity of the symptoms increases over time.

The following symptoms are typical signs of urethral stricture:

🔵 1) Weak and thin urine stream

It is the most common symptom.

🔵 2) Intermittent urination

In this situation, immediate action is required.

🔵 11) Blood in the urine

In modern urology, it is important to evaluate urethral stricture with a definitive diagnosis.

In my clinical practice, I follow these steps in this order:

The patient's urine flow rate is measured.

If there is a restriction, the “peak flow rate (Qmax)” is low.

Normal: 15–25 ml/s

Stenosis: 5–10 ml/sec

The graph is not a "bell curve" but rather a jagged sawtooth pattern.

It is the most definitive diagnostic method.

A camera is inserted into the urethra to visualize the location and degree of the stricture.

Retrograde urethrogram (RUG): An X-ray is taken after contrast dye is injected into the urethra.

It clearly shows the location and length of the constriction.

SUG (sonographic urethrography), on the other hand, provides imaging using ultrasound.

The amount of urine remaining in the bladder is measured.

One possible cause of the narrowing could be an infection.

Any narrowing that remains untreated tends to progress.

Over time, the following tables are developed:

•The bladder wall thickens

•The bladder muscle weakens

•Pressure returns to the kidneys

•Painful urinary retention develops

•Kidney failure may occur

•Recurrent infections occur

•Sexual function may be affected

For this reason, urethral stricture does not resolve on its own and must be treated.

All Options in Modern Urology

Treatment for urethral stricture depends on the nature of the stricture:

•Location

•Length

•Depth

•Whether it repeats or not

It is planned entirely on an individual basis, taking into account factors such as these.

We examine treatment options in four main categories:

This method was used more frequently in the past.

Now we only use it for very short and mild episodes of constipation.

How do you do it?

The channel is widened using metal or silicone spark plugs.

Disadvantages:

•The success rate is low

•There will be another contraction soon

•It can cause trauma and make the situation worse

Not recommended for recurrent narrowing.

It is the most commonly performed procedure for urethral stricture in Turkey.

How do you do it?

•The endoscope is inserted into the narrowed area

•The scar tissue is incised at the 12 o'clock position

•The urethra opens

•The catheter usually remains in place for 3–10 days

Advantages:

•Fast, easy, minimally invasive

•For short-term shortages (up to 70% success rate)

•Good results in cases of first-time stenosis

Disadvantages:

•Success rates drop to 20–30% in cases of recurrent stenosis

•It is ineffective in long-segment strictures

It is not scientifically recommended to perform more than one OIU

→ Because each procedure creates more scar tissue.

Urethroplasty is the most successful and long-lasting treatment for urethral stricture.

International guidelines (AUA–EAU) recommend direct urethroplasty for long-segment strictures.

There are two basic techniques:

If the stricture is less than 2 cm, this is the ideal treatment method.

How do you do it?

•The segment containing the stenosis is completely removed

•The sturdy ends are sewn together

•The channel returns to its natural width

Success rate:

➡ 90–95% (the most permanent method)

If the stricture is long (2–6 cm or longer)

A sample of oral mucosa is taken from the inside of the cheek and applied to the urethra as a patch.

This technique is one of the most successful surgical procedures in modern urology.

Graft used:

•Buccal mucosa (inside of the cheek)

•It is a highly durable, flexible tissue that is most compatible with the urethra

Success rate:

➡ 85–90%

Because the vessel is chronically inflamed, long-segment strictures develop.

Treatment is planned on a multidisciplinary basis.

Posterior urethral injuries associated with pelvic fractures require specialized surgery.

Repeat surgeries may be necessary.

I follow up with my patients after urethrotomy or urethroplasty as follows:

✔ Probe duration

•OIU: 3–10 days

•Urethroplasty: 10–21 days

✔ Urine test

After the catheter is removed, a uroflow test is performed.

✔ Radiological monitoring

Recovery is assessed using the RUG as needed.

✔ Infection monitoring

⸻

THE RECURRENCE RATE VARIES DEPENDING ON THE TREATMENT:

🔹 Dilation

➡ The most frequently used method

➡ It can recur even within a few weeks

🔹 OIU (Endoscopic resection)

➡ Recurrence rate: 30–60%

➡ It is valuable as the first step in a short squeeze

➡ Its effectiveness decreases with repeated episodes of narrowing

🔹 Urethroplasty (open surgery)

➡ The most permanent treatment

➡ Recurrence rate: 5–15%

➡ Success rates are highest, particularly with the end-to-end method

In surgeries performed using the correct technique:

•Erectile dysfunction does not develop

•There is no loss of sexual sensation

•Ejaculation is not affected

The only exception:

Post-traumatic posterior urethral injuries

In some patients, it may be accompanied by erectile dysfunction.

⸻

No.

No. It does not break up scar tissue.

In cases of long strictures → urethroplasty

For short-term shortages → OIU

Usually 1–2 weeks.

Usually after 4–6 weeks.

⸻

Urethral stricture is a serious scarring condition that should not be taken lightly.

If left untreated, it first damages the bladder and then the kidneys.

However, in modern urology, this condition can now be treated with great success.

I always tell my patients:

“Urethral stricture is not inevitable.

"It is a problem that can be completely resolved with the right treatment."

Urethroplasty, in particular, is currently the gold standard and the most lasting solution for urethral stricture.