Stricture, in medical sense, means narrowing of a tubular passage in the human body usually resulting from damage or injury. The urethra, on the other hand, is a tubular passage through which urine flow its reservoir in the body (urinary bladder) to the outside. The urethra is much longer in men than in women. In men, most of the urethra is lodged within the penis where it also serves as passage for semen (sperm) during sexual intercourse. This dual role as well as the longer length of the urethra predisposes men to urethral stricture (narrowing of the urethra) – a problem which is very rare in women.
When the urethra is narrow, urine can no longer flow freely through the passage to the outside in the affected person. Urethral stricture is one of the two causes of obstruction to the flow of urine in men, the other ones being an enlargement of the prostate gland. (the male organ sitting below the urinary bladder). While prostate enlargement is confined to men above the age of 50 years, urethral stricture occurs mainly in young men below the age of 50 years.
1. Some children are born with urethral stricture although this is a rare condition
2. The narrowing, when located at the tip of the penis, may be caused by badly-performed circumcision. Infection of a fresh circumcision wound may also lead to ulceration and subsequent narrowing at the tips of the penis.
3. Various types of injury to the urethra may cause stricture. When a man falls astride a man-hole and sustains injury to the tissues near the scrotum or fractures the bones of the waist (fractured pelvis) following a major road traffic accident, the urethra may be injured.
4. The used of certain instruments such as catheters or blunt metallic instrument in the course of medical treatment of a patient may cause damage to the urethra and may result in stricture unless appropriate care is taken by the doctor in charge.
5. The most important cause of urethral stricture in developing countries, however, is gonorrhoea. Unless treated early and with appropriate drugs, this infection damages the urethra and stricture may result some years after the infection has apparently cleared.
SYMPTOMS AND SIGNS
If a man under the age of 50 years has to strain before he can pass his urine, then the probability that he has urethral stricture is very high. Apart from straining, the urinary stream may be split in two or more parts and it may be interrupted before the end of urination. For a while after the patient has finished passing urine, he may discover the drop of urine continue to come out from the penis (terminal dripping) leading to wetting of his pants.
Those with severe urethra stricture may suddenly discover that they are not able to pass urine despite an intense urge to do so (acute retention). This very painful condition demands an emergency hospital treatment. The retention may develop gradually over many weeks or months. The urinary bladder will be full of urine all the time in such patient and urine may escape from the tip of the penis without the patient being able to hold it (chronic retention with overflow).
When a doctor is consulted, he may be able to feel the portion of urethra affected by stricture as a thickening along the penis. Special tests age needed to confirm the diagnosis. As x-ray of the urethra taken after injecting a special fluid into the urethra (urethrogram) will show the length and the degree of the stricture.
i. Infection is a common complication in patients with urethral stricture. Infection of the urinary passage itself can spread to and damage the kidneys or predispose to formation of solid concretion (stones) along the urinary tract. Infection of tissues around the urethra may lead to boils in the scrotal region.
ii. The obstruction to the outflow of urine caused by the stricture can cause a “back pressure” effect on the urinary bladder and the tubes linking it with the kidneys (ureters). This “back pressure” effect causes the ureter to dilate and may destroy the kidneys when it is allowed to persist. This is one of the ways in which kidney failure can occur and it rapidly results in death.
iii. The strain to pass urine in stricture patients may cause hernia and piles.
iv. Infertility may occur in a stricture patient (inability to make a woman pregnant). This is because the passage for the sperm is commonly blocked by the same infection contains no spermatozoa hence their inability to make a woman pregnant.
There are two main ways patient with stricture can be treated. Many stricture patients can be satisfactorily treated with regular and intermittent dilation of the urethral passage. The procedure is painful hence is better to have some form of anaesthesia (local or regional) before it is done. This form of treatment can cause bleeding, creation of a false urethral passage, and sometimes a dangerous form of infection of the patient’s bloodstream called septicaemia but these are not common. Unfortunately, it is not all strictures that can be dilated. When this happens, a temporary passage is often required in the lower abdomen to allow urine to flow out directly from the urinary bladder, through a rubber tube. Subsequently, such a person may require an operation to create a new urethral passage which is similar to the natural one. This operation is usually done in two ways or more stages before it is completed.
Africans are said to be more prone to forming hard scars and strictures. Therefore, the best thing is to prevent urethral stricture by observing the following rules:
1. Circumcision must properly done and infection must not be allowed in fresh wound
2. Medical treatment must be sought promptly when urethral injury occurs.
3. Avoid sexual contact with people who are likely to have gonorrhoea-prostitutes and `women with multiple sexual partners.
4. Use condom if you must engage in multiple sexual intercourse.
5. Consult a doctor early for appropriate treatment when you have gonorrhoea. Gonorrhoea, in this environment, has become resistant to most drugs in the market. Therefore, do not waste time trying drugs from chemist shops or native doctors. Delay in treatment increases the chances of developing urethral stricture.
6. A man who discovers that he has gonorrhoea must also take his wife for treatment. Otherwise, cure may be difficult to achieve as he likely to be re-infected. Of course, either the man or his wife could have been the first acquire the infection before transfer to the partner; so, the question of who is right or wrong should not arise.
In conclusion, urethral stricture, in most cases, is a late complication of badly treated or untreated gonorrhoea and as the saying goes “prevention is better than cure”. However, when it occurs, cure is an achievable goal.