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Clinical Presentation

Any patient who presents with poor flow may have a stricture. Other symptoms are:

  • hesitancy
  • poor flow
  • feeling of incomplete bladder emptying
  • dysuria
  • urinary tract infection.

Many patients know they have a stricture and are under treatment.

After dilatation the patient may get pain, fever, bleeding per urethra.

I have seen patient presenting with chronic renal failure due to back pressure changes and a patient after kidney transplant still being treated with dilatation.

Watering can perineum though rare now a days may be the presenting symptom.

Patients with Lichen Sclerosus may have undergone circumcision and or meatoplasty.

Many patients are on intermittent self catheterization.

Rarely a patient may present with a lump in the perineum due to urethral carcinoma.

Painless bleeding per urethra is a leading symptom of patients with urethral hemangioma.



Any patient who presents with poor flow needs uroflowmetry.  Hesitancy and poor flow, less than 10ml/sec with a flat box type of curve suggests a stricture in the urethra.

Urethroscopy and Cystoscopy

Many times a stricture is diagnosed when a panendoscopy is performed for other problem such as TURP or Bladder stone.

USG abdominal and urethral

Sonography of the abdomen and pelvis is necessary to check the backpressure changes in the upper tracts like bilateral hydroureteronephrosis.

Significant post void residual urine volume indicates significant obstruction and or decompensated detrusor. Bladder wall thickness is also an important measurement.

Urethral sonography is performed with high frequency probe after introducing saline or jelly in to the urethra.  Sonography gives accurate information about the length and depth of spongiofibrosis. 

Duplex Color Doppler of the Penis

For all impotent patients’ pre and post Papavarine injection into the penis with duplex color Doppler to demonstrate the arterial insufficiency or not is useful.  In patients who have   butterfly fracture of the pubic rami, the patient may have arteriogenic impotence. Ideally these patients need revascularization procedure preoperatively.  Otherwise, this patient may land with bulbar urethral necrosis following mobilization and proximal transection of the bulbar urethra as this part gets its blood supply in a retrograde fashion through corpora cavernosa into glans and penile urethra.  As this retrograde blood supply is inadequate the bulbar urethra undergoes necrosis or stenosis. 

Ascending and Descending urethrogram

This is the most important investigation for stricture urethra.  Ascending urethrogram gives us the distal urethral information regarding distensibility or narrowing and irregularity of urethra.  The descending urethrogram provides information regarding the proximal urethral anatomy. The drawback of the investigation is because of the semi lateral position; the length of the stricture in the bulbar urethra is under estimated.  Forceful injection of the contrast into the meatus may lead to intravasation of the contrast into veins. 


3 D CT reconstruction / MRI are useful investigations for pelvic fracture urethral injuries.  It shows the site and size of hematoma due to injury. 

Biopsy- for BXO, suspected urethral cancer

Biopsy of the urethra, glans and prepuce is necessary to establish the diagnosis of BXO.  Suspected mass lesion in the urethra is biopsied to rule out the diagnosis of urethral cancer. 

Preop Investigations

Hemogram, Urea Creatinine, Urine routine and culture, Sugar, Xray chest, ECG, Blood group etc.

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