What are some causes of urethral stricture?
Most strictures in the anterior urethra are related to sexually transmitted infection (STI) such as by gonorrhea or other nongonococcal pathogens. Although uncommon in the developed world, granulomatous infections such as by tuberculosis can also cause strictures in the urethra. Both tuberculous and nontuberculous urethritis may cause fistulae to occur between the urethra and the adjacent soft tissues or perineal skin. When the fistulae are multiple, the process is referred to as a “watering can” perineum.
Chronic urethral strictures can cause difficulty in emptying the urinary bladder and result in complications such as bladder stone formation or recurrent infections. Chronic strictures are also a risk factor for the development of carcinoma at the stricture site. If a stricture has an irregular appearance on a urethrogram, endoscopic inspection of the urethra and biopsy as needed are performed.
Trauma to the anterior urethra, such as a straddle injury, can injure the bulbar urethra and result in a stricture. Pelvic fractures can injure the posterior urethra and result in strictures in the healing phase. Cystoscopy, particularly in young boys, can traumatize the urethra and result in strictures, most commonly at the urethral meatus, the penoscrotal junction, and the bulbomembranous junction; these sites are all areas of natural narrowing in the urethra, which makes them vulnerable to injury from prolonged endoscopic procedures. Chronic indwelling Foley catheters can also result in strictures at the same sites.