Bulbar (meaning “bulb shaped”) urethral stricture is an obstruction of urine flow through the urethra, which impedes the body’s ability to pass urine. Bulbar urethral stricture can occur in varying severity from light strictures with limited symptoms and some continued flow of urine, to complete and acute obstructions with severe symptoms and no urine passage. Symptoms or suspicions of bulbar urethral stricture should always be consulted with a doctor.
Learn about the urethra
Bulbar urethral stricture can arise from a variety of causes but most commonly occurs when the urethra has been exposed to manipulation from e.g. a repeated treatment of brachytherapy (a form of prostate cancer treatment), prostatectomy, or from use of urethral catheters. Bulbar urethral stricture may also be caused by scar tissue from sexually transmitted diseases, bacterial infections etc.
Diagnosis of bulbar urethral stricture typically involves analyzing the patient’s full medical history to understand if any of the common causes have been observed, as well as general questions about symptoms. A variety of testing methods can be applied ranging from MRI and CT scans, ultrasound measurements, as well as e.g. urethroscopy where a scope is inserted into the urethra to see if a stricture has occurred.
The symptoms of bulbar urethral stricture typically vary in magnitude depending on the severity of the stricture. If you are in doubt about whether you are experiencing symptoms, a doctor can examine and evaluate if treatment is necessary. Examples of bulbar urethral stricture symptoms can be seen below
The optimal treatment of bulbar urethral stricture typically depends on patient history, the severity of the symptoms as well as the length of the stricture. Below follow examples of how bulbar urethral strictures can be treated including examples of their respective advantages and disadvantages.
If the symptoms of bulbar urethral stricture are limited in severity and do not interfere with the patient’s everyday life, some doctors may prefer to simply monitor the condition and follow up frequently to evaluate the development in symptoms closely. Watchful waiting has the advantage of no side-effects or complications but comes with the risk that the condition is not treated in due time.
Balloon dilatation is typically the first method attempted to provide symptom relief. Balloon dilatation is generally performed under local anesthesia by means of a special balloon catheter which stretches the stricture to provide urine passage. Balloon dilatation is non-invasive, but often must be repeated regularly to sustain the passage and does cause risk of e.g. bleeding and infection.
The stricture can also be cut open by use of laser or a scalpel. Incisions are more invasive than balloon dilatation but typically provide longer term symptom relief. A catheter may be inserted through the stricture to hold open the gap after the incision, to allow it to heal. Though more effective than dilatations, some strictures reappear after a period, upon which a new incision or a different treatment can be performed.
Catheters are long plastic tubes plastic inserted through the stricture in the urethra to enable urine flow. Catheters can be single-use devices for self-catheterization, or indwelling catheters which are fixed in the body and exchanged approximately every 15-30 days. Catheters are less invasive than surgery but may also cause discomfort and pain to the user, affect quality of life, and carry a high risk of urinary tract infections.
Bulbar urethral stricture can also be treated through major surgery called urethroplasty. Urethroplasty is an open surgical reconstruction or replacement of the urethra. Urethroplasty is effective in relieving symptoms both in long and short term but is a major surgery with its common risk factors. Urethroplasty also causes risks of e.g. sexual dysfunctions like impotence.
Stents are short tubes fixed at the location of the stricture to allow urine to pass through. Stents are less invasive than surgery and affect the everyday life of patients less than catheters, but cause risk of obstruction from kidney stones, and may pass involuntarily through the urine. In either case the stents can be replaced by a new one or replaced with different treatment method. Certain non-metallic stents also cause risk of tissue growth into the stent, making the removal process difficult.
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