⚠️ Men's Health

Urethral Stricture (Nigeria Guide)

Q: Can urethral stricture be cured?

Yes. Urethroplasty (open surgical reconstruction) cures 85–95% of bulbar urethral strictures. It is not as widely available in Nigeria as it should be, but is performed at major teaching hospitals. Repeated dilatations and urethrotomies are less effective and may make subsequent surgery harder.

Q: Is urethral stricture linked to gonorrhoea?

Yes — in Nigeria, gonorrhoea is the most common cause of urethral stricture. Incomplete or incorrect treatment allows the infection to cause urethral scarring over months to years. This is why prompt, correct antibiotic treatment of gonorrhoea is essential — and why self-medicating with whatever antibiotic is available is dangerous.

Q: How do I know if my weak stream is from prostate or stricture?

Both BPH (prostate) and urethral stricture cause weak stream. The key differences: stricture is more common in younger men (20–50) and is often preceded by gonorrhoea, trauma, or catheterisation. BPH is more common in men over 50 with no prior urethral injury. Imaging (urethrogram) and uroflowmetry distinguish them.

Q: Is the procedure to widen the urethra permanent?

Dilatation and urethrotomy are not permanent — most strictures recur. Urethroplasty gives durable long-term cure. If your stricture has been dilated more than twice and keeps returning, ask for a surgical reconstruction (urethroplasty) referral.

Narrowing of the urethra from infection or injury — a common Nigerian urological problem

Urethral stricture — narrowing of the urethra due to scar tissue — is extraordinarily common in Nigerian men, yet underdiagnosed and undertreated. The most common cause in Nigeria is poorly treated or untreated gonorrhoea, followed by trauma (road traffic accidents, perineal injuries, post-catheterisation). The result is a progressively narrowing urinary stream, urinary retention, and recurrent infections. Without treatment, it causes chronic kidney disease and life-threatening sepsis. The cornerstone of prevention is prompt, correct antibiotic treatment of gonorrhoea.

Signs and Symptoms

✓ Progressively weakening urinary stream — reduced force over months to years

✓ Spraying or split stream — urine sprays in multiple directions

✓ Straining to urinate — abdominal muscles engaged to void

✓ Incomplete bladder emptying with post-void dribbling

✓ Urinary frequency and urgency from incomplete emptying

✓ Urinary tract infections — recurrent, because stasis promotes bacterial growth

✓ Acute urinary retention — sudden complete inability to urinate

✓ Perineal or scrotal pain and swelling if periurethral abscess develops

Risk Factors

Gonorrhoea (most common cause in Nigeria) — poorly treated or untreated urethral infection causes inflammation and scarring
Trauma — road traffic accidents (straddle injuries), pelvic fractures, urethral instrumentation
Urethral catheterisation — especially prolonged catheterisation or repeated traumatic catheterisation
Urethral surgery — hypospadias repair, previous stricture treatment
Balanitis xerotica obliterans (BXO) — meatal and anterior urethral strictures
Tuberculosis — rare cause of urethral stricture

When to Seek Help

EmergencyComplete urinary retention — inability to pass urine at all — requires emergency suprapubic catheterisation (not urethral, which worsens the stricture)

EmergencyFever, perineal swelling, and urinary difficulty — periurethral abscess, a urological emergency

SoonProgressive weakening of urinary stream over weeks to months — stricture evaluation needed before retention occurs

RoutinePost-gonorrhoea urethral symptoms — early stricture detection is treatable before becoming complex

UrgentUrinary difficulty in a patient who has had a pelvic fracture or urethral instrumentation

Tests & Diagnosis

🧪 Uroflowmetry

Measures urine flow rate — reduced maximum flow rate (Qmax <15 ml/second) indicates obstruction. Simple, non-invasive, available at most urology units

🧪 Retrograde urethrogram (RUG)

Contrast dye injected into the urethra and X-ray taken — shows location, length, and severity of stricture. The essential imaging investigation

🧪 Ascending urethrogram + micturating cystourethrogram (MCU)

Combined study shows both the stricture and bladder outlet. The most comprehensive imaging

🧪 Urethroscopy (cystoscopy)

Direct visualisation of the stricture. Can assess depth and complexity — guides surgical planning

🧪 Post-void residual ultrasound

Incomplete emptying — indicates obstruction severity and risk to upper tracts

🧪 Renal function (creatinine)

Bilateral obstruction or chronic incomplete emptying can cause kidney impairment

Treatment Options

URGENT — Treat gonorrhoea promptly and correctly

The primary prevention message: gonorrhoea must be treated with the correct antibiotic (ceftriaxone 500 mg IM) + azithromycin 1 g oral, not partial doses of ciprofloxacin or amoxicillin which are now largely resistant. Inadequate treatment leads to stricture

Urethral dilatation (bougie dilatation)

Gradual dilation of the stricture with sounds (metal dilators). Provides temporary relief but high recurrence rate — stricture returns in most cases within months. Often used as first-line temporary measure or while awaiting definitive surgery

Urethrotomy (optical internal urethrotomy — OIU)

Endoscopic incision of the stricture under direct vision. Good for short strictures (<1 cm). High recurrence — 50–60% recur within 2 years. Repeated urethrotomy not recommended — increases fibrosis and makes subsequent repair harder

Urethroplasty — the definitive treatment

Open surgical reconstruction of the stricture — the gold standard. Various techniques: end-to-end anastomosis (excision and primary anastomosis) for short bulbar strictures, buccal mucosal graft (tissue from the inner cheek) for longer strictures. Available at LUTH, UCH, NINR, and major teaching hospitals. 85–95% success rate for bulbar strictures

Suprapubic catheter (long-term)

For men unfit for surgery or awaiting urethroplasty — a catheter through the lower abdomen into the bladder. Not a permanent solution — bladder problems develop long-term

Self-dilatation (intermittent self-catheterisation)

After urethroplasty or urethrotomy, some patients are taught to pass a fine catheter themselves weekly to maintain the urethra. Reduces recurrence rate significantly

Frequently Asked Questions

Can urethral stricture be cured?

Yes. Urethroplasty (open surgical reconstruction) cures 85–95% of bulbar urethral strictures. It is not as widely available in Nigeria as it should be, but is performed at major teaching hospitals. Repeated dilatations and urethrotomies are less effective and may make subsequent surgery harder.

Is urethral stricture linked to gonorrhoea?