Stricture or narrowing of the bladder neck and urethra is usually associated with a previous surgery (TURP, TURB, radical or partial prostatectomy) or prostate sclerosis, trauma, which can also be caused by acute or chronic prostatitis.
The constriction of the bladder neck and urethra is caused by a strong scarring process, resulting in difficulties emptying the bladder. In more severe cases, there may be complete retention (urinary retention), bladder stones, or recurrent urinary tract infections (UTI). Modern studies have identified trauma, urethral injury associated with pelvic fractures, various instrument procedures, previous bladder neck surgery, and previous prostate surgery and/or radiation as the causes of the condition. Inflammatory strictures are usually associated with the disease “lichen sclerosis,” which may be associated with panurethral stricture disease, which generally does not respond to endoscopic treatment. The incidence of bladder neck strictures is up to 600 cases per 100,000 people.
The hallmark of urethral stricture is a change in the urine stream. Depending on the location of the stricture, the urine stream can be thin and strong or thick, but sluggish and small in arc. Urine stream splitting may occur. Urine may periodically exit in droplets. A characteristic feature is residual urine, or the dripping of urine after the end of urination, caused by urine retention in the dilated portion of the stricture. Chronic prostatitis or inflammation of the prostate gland caused by urethral stricture can cause constant itching in the urethral area.
The surgery is a controlled alternative to urethral dilation. With the aid of an endoscope, an incision is made in the scar tissue of the urethra or bladder neck under visual control. When the necessary diameter of the stricture is achieved, a permanent catheter is placed in the bladder to maintain the size of the opening and ensure hemostasis.