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Urethral strictures in men

Author
Andrew Peterson, MD
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Urethral strictures are relatively common in men. The most common etiology is idiopathic in developed countries and trauma in developing countries [1]. Iatrogenic injuries, such as oversized resectoscope at the time of transurethral surgery and traumatic placement of indwelling urinary catheters, account for 45 percent of all cases [2]. Other causes of urethral strictures include infection (including sexually transmitted disease), hypospadias, skin conditions (most commonly lichen sclerosus), trauma (most commonly pelvic fracture), and radiation therapy (table 1).

The clinical manifestations, diagnosis, and management of urethral strictures in men are discussed here. The diagnosis and treatment of other lower urinary tract diseases are discussed in other topics. (See "Lower urinary tract symptoms in men" and "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis" and "Acute urinary retention" and "Approach to infectious causes of dysuria in the adult man".)

ANATOMY AND PATHOPHYSIOLOGY

The urethra conveys urine from the bladder to the exterior of the body. The anatomy is important here because male urethral strictures differ in etiology, diagnosis, and management based upon stricture locations.

The male urethra is divided into two major segments: the anterior urethra and the posterior urethra (figure 1). By convention, the surfaces of the penis are defined with the penis extended cranially and the urethra located ventrally.

The anterior urethra begins at the meatus of the penis and includes the fossa navicularis, the pendulous urethra, and the bulbar urethra. The suspensory ligament of the penis delineates the pendulous and bulbar urethra. The anterior urethra consists of an epithelial layer that is surrounded by the corpus spongiosum. The spongiosum is concentrically located around the urethra in the distal pendulous urethra. In the bulbar urethra, it becomes eccentrically located with a larger component on the ventral surface.

                                 

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Literature review current through: May 2017. | This topic last updated: Jun 06, 2017.
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