• Definition: a narrowing of the urethra that obstructs the flow of urine.

• Symptoms: weak stream, straining to urinate, pain with urination, feeling like the bladder is not empty, taking 40sec or longer to urinate to completion.

  • If the stream progressively weakens, notify us or your local urologist. If you wait too long, you may end up in acute urinary retention (inability to urinate with an uncomfortably and sometimes painful bladder filled with urine); this would require ER evaluation.

• The most common locations of a stricture include the tip of the penis urethra and at the connection between portions of urethral lengthening (example: between the penis UL and minora UL).

  • For metoidioplasty, the most common location is near the connection to the original urethra.

• Penis swelling may act like a stricture as it compresses the urethra from the outside; swelling resolution will lead to improved voiding symptoms.

• Risk factors for stricture formation:

  • Decreased blood flow:

    • The tip of the urethra is furthest away from the blood vessels.

    • The urethral connection between the phallus urethra and the minora urethra are subject to increased tension, which can lead to decreased blood flow.

  • Smoking, poor nutrition​

• Note: strictures and fistulas may sometimes occur together as they may derive from a similar cause, such as decreased blood flow.​

​

SURGERY FOR STRICTURES

• Strictures rarely resolve on their own. They often require intervention.

  • Dilation vs Urethroplasty​

• Cystoscopy and urethral dilation​ with/without steroid or drug injection (an alternative similar treatment is cutting the stricture internally called direct vision internal urethrotomy or DVIU)

  • A camera is inserted into the urethra, and the location(s) of the stricture(s) determined. 

  • Dilation: A guidewire is placed into the narrowed urethral segment, and tapered, surgical dilators are passed over the wire from small to larger in diameter to sequentially stretch the stricture. Sometimes steroid or other scar modulating medication is injected into the scar tissue.

  • DVIU: a special camera with a knife is used to cut the stricture; laser can also be used to cut the stricture.

  • There is no cutting of skin​

  • Catheter duration: about 3-7 days 

  • Success rate: about 40-50% 

• Urethroplasty: 

  • An incision or incisions are made through the skin depending on the location of the stricture(s). Example includes in front of the scrotum to gain access to the most common stricture site.​

  • The stricture is opened and scar tissue is removed, leaving a defect.

    • Small defects can be treated by sewing the neighboring healthy urethral tissue together.​

    • Larger defects are repaired with mouth and/or skin grafts.

    • Largest defects with minimal neighboring healthy tissue are repaired with staging, where the urethral segment is grafted and patients sit to urinate until the grafts mature. Six months later, the open urethral segment is tubularized and the wound closed.

  • Catheter duration: about 2-4 weeks, depending on the type and location of the urethroplasty. 

  • Success rate: about 80%

    • Success rates are lower for more complex strictures.​

​​​

​

AFTER URETHROPLASTY OR CYSTOSCOPY WITH DILATION/URETHROTOMY

​

Follow-up care is typically scheduled every 3–6 months to monitor recovery and ensure the stricture does not recur. During these visits, discussing the force of your stream and ease of voiding provides essential clinical insight.

To evaluate these factors objectively, uroflowmetry (also known as a uroflow test) is performed in the office. This test measures peak flow rates, average flow rates, void times, and void volumes. The resulting data helps the urologist determine if there is a urethral obstruction, which may indicate that the stricture has recurred.

 

Home Monitoring for Non-Local Patients

For patients living outside the immediate area, an average flow rate in milliliters per second (mL/sec) can be calculated at home every 1–3 months.

1. Preparation: Wait until you have a full bladder and a strong urge to urinate.

2. Procedure: Urinate into a graduated measuring container (a large cup with measurement lines) and time the duration of urination from start to finish.

3. Calculation: Divide the total volume (mL) by the total time (seconds).

   • Example: If you urinate 300mL in 30 seconds (300/30 = 10), your average flow rate is 10mL/sec.

Understanding Your Results

Average flow rates help quantify the quality of the urinary stream:

• 10mL/sec: Generally considered within the expected or typical range.

• 5mL/sec: Below the expected threshold and may require clinical evaluation.

A trend of consistently weak streams or decreasing average flow rates is a clinical indicator that a stricture may be developing.

​

NOTE: Symptoms and uroflow tests provide important data but do not definitively confirm or rule out a stricture. If a combination of symptoms and test results raises suspicion, the diagnosis is confirmed via cystoscopy (using a small camera to examine the urethra), followed by urethroplasty or dilation/urethrotomy if clinically indicated.