The urethra is the tube that carries urine from your bladder out of your body. A urethral stricture is scar tissue that has formed inside this tube — narrowing it like a pinched hose. The narrower it gets, the harder it is for urine to pass through, and the worse your symptoms become.
Urethral strictures almost exclusively affect men, because the male urethra is about 20 cm long — passing through the prostate, the pelvic floor, and along the underside of the penis — giving scar tissue many places to form. The female urethra is much shorter (about 4 cm) and strictures are very rare.
Strictures are categorized by their location, length, and severity. A short stricture (<1–2 cm) in a favorable location responds well to simpler treatments. A long, complex, or recurrent stricture almost always requires definitive surgical reconstruction (urethroplasty) for lasting results.
Any injury or inflammation to the urethra can trigger scar tissue formation. The most common causes in today’s practice:
A direct blow to the perineum (the area between the scrotum and rectum) — from a fall onto a bicycle crossbar, a straddle injury, a car accident, or a pelvic fracture — can crush or tear the urethra. Pelvic fracture urethral injuries are some of the most challenging strictures to repair and often require specialized reconstruction.
Passing instruments through the urethra — urethral catheters (especially repeated or long-term), cystoscopes, resectoscopes (used during TURP), and ureteroscopes — can traumatize the urethral lining and leave scar tissue. This is one of the most common causes in older men with histories of urological procedures.
Historically, gonorrhea was the leading cause of urethral strictures — untreated gonorrheal urethritis caused dense inflammation and scarring. While less common now, gonorrhea and other sexually transmitted infections (chlamydia, non-specific urethritis) can still cause strictures when not treated promptly.
Radiation to the prostate or pelvis — for prostate cancer, bladder cancer, or rectal cancer — can cause progressive fibrosis (scarring) of the urethra in the months to years after treatment. Radiation-induced strictures tend to be long and complex, with poor tissue quality, making them among the most challenging to reconstruct.
Lichen sclerosus (also called balanitis xerotica obliterans or BXO) is a chronic inflammatory skin condition that causes progressive white scarring of the foreskin, glans, and — over time — the urethra. It is the leading cause of panurethral (entire-length) strictures in men and requires special treatment techniques because the affected tissue cannot be used for reconstruction.
In a significant minority of men — particularly those with a bulbar urethral stricture (in the perineal segment) — no specific cause can be identified. These are thought to represent microtrauma from cycling, perineal pressure, or unrecognized minor injury that occurred years earlier.
Urethral strictures almost always cause problems with urination — but symptoms often develop so gradually that men adapt to them without realizing how much their function has declined. Many men first notice something is wrong when a routine urine flow test shows their stream is far below normal.
Often the first and most prominent symptom. Flow rate drops progressively as the stricture tightens. Many men don't realize how slow their stream has become until they see objective flow measurements.
Needing to push or bear down to begin urinating, or to keep the stream going once it starts. May feel like significant effort is required for what should be effortless.
A persistent sensation that the bladder hasn't fully emptied, often with a need to return to the toilet shortly after voiding.
Urine sprays in multiple directions or in a forked stream rather than a single steady flow — caused by the deformed urethral opening narrowed by scar tissue.
Urine that continues to leak or drip after finishing urination, sometimes for a minute or more, as residual urine trapped behind the stricture slowly drains out.
Stagnant urine behind the obstruction becomes a breeding ground for bacteria. Repeated UTIs in a man — especially if they keep coming back — should prompt evaluation for stricture.
Complete inability to urinate — a medical emergency. When a stricture tightens enough, nothing can get through. Requires emergency catheterization and urgent urological referral.
A discharge from the tip of the penis — not from an infection, but from fluid accumulating behind the stricture, or from an associated periurethral abscess in severe long-standing cases
The urethral obstruction caused by a stricture puts back-pressure on the bladder. Over months to years, this can permanently damage the bladder muscle, making it unable to contract properly — even after the stricture is fixed. Getting evaluated and treated before this happens protects long-term bladder function.
You urinate into a special electronic device that measures your flow rate — peak flow in mL/second and total voided volume. A normal peak flow is over 15 mL/sec; a stricture typically reduces this to 5–10 mL/sec or less. This is the simplest first screening test and can be done in the office.
An ultrasound probe placed on your lower abdomen measures how much urine remains in your bladder after voiding. A large residual (over 100–150 mL) confirms significant obstruction and helps assess how much the bladder is being affected.
The definitive imaging test for urethral strictures. Contrast dye is gently injected into the urethra at the tip of the penis, and X-ray images are taken as it flows up toward the bladder. This shows exactly where the stricture is, how long it is, and how severe the narrowing is. A voiding cystourethrogram (VCUG) may be added — contrast fills the bladder through a catheter, then you void while X-rays are taken — to visualize the stricture from both ends.
A thin flexible camera is passed into the urethra to directly visualize the stricture. This gives Dr. Bansal direct information about the narrowing's appearance, caliber, and the quality of the surrounding tissue. In some cases, a calibration trial with urethral sounds (smooth metal dilators) also helps characterize the stricture while providing temporary relief.
A high-frequency ultrasound probe along the underside of the penis can measure the actual length of spongiofibrosis — the scar tissue extending into the tissue surrounding the urethra. This is more informative than the RUG in planning complex reconstruction, as it reveals the true extent of the disease beyond what the dye alone shows.
The choice of treatment depends on the stricture’s length, location, cause, and whether it has been treated before. Simple short strictures may respond to dilation or an internal cut. Long, complex, or recurrent strictures almost always require urethroplasty — surgical reconstruction — for a durable cure.
Dilation stretches the narrowed segment of the urethra using progressively larger dilators passed through the urethral opening. It can be done in the office using local anesthetic gel, or under brief sedation. It provides immediate relief of symptoms and is the simplest and least invasive option available.
Dilation is best thought of as a temporary measure — useful for emergency situations, for buying time before definitive surgery, or for men who are not surgical candidates. Repeated dilations over years are not a substitute for proper treatment and can make eventual urethroplasty more difficult.
Some men with recurrent short strictures learn to periodically pass a catheter themselves to keep the urethra open — a technique called CISC. When done consistently, it can maintain acceptable urine flow and delay or prevent recurrence. Dr. Bansal teaches this technique to appropriate patients and provides the necessary supplies.
DVIU is an endoscopic procedure done under general or spinal anesthesia in which a cold knife or laser is used to cut through the scar tissue inside the urethra, allowing it to spring open and widen. A camera guides the cut under direct vision — hence “direct vision” — distinguishing it from blind dilation. A urethral catheter is left in place for 1–3 days afterward while the cut heals open.
DVIU has an acceptable success rate (about 50–70%) for a single, short (<1.5 cm), first-time bulbar urethral stricture. For any other stricture — longer, penile location, recurrent, or caused by lichen sclerosus — the success rates fall dramatically (often below 30%), and repeat DVIU just adds more scar tissue without fixing the problem.
Multiple endoscopic treatments for a recurring stricture do not improve the odds of success — they progressively worsen the scar and make future surgical reconstruction more difficult. If a stricture comes back after one DVIU, urethroplasty is almost always the right next step.
No. Scar tissue doesn't reabsorb on its own — once a stricture forms, it stays and often slowly tightens further over time. The good news is that treatment is effective and highly successful when the right approach is chosen for the specific stricture.
Yes — and for most men in this situation, urethroplasty is exactly what should happen next. Repeated dilations may have made the stricture somewhat longer or the surrounding tissue slightly more scarred, but this is taken into account in surgical planning. Urethroplasty success rates are not dramatically lower after prior dilations, and the sooner you transition to definitive surgery, the better.
In most cases, no. Bulbar urethroplasty (the most common type) has a very low rate of erectile dysfunction (<1–2% in experienced hands) and does not affect ejaculation. Penile urethroplasty also generally preserves sexual function. Pelvic fracture urethral injury repairs carry somewhat higher rates of erectile dysfunction — partly from the original injury, not just the surgery — and this is discussed in detail before the procedure.
Typically 3–4 weeks. This is longer than most people expect, but it's important — the reconstruction needs time to heal before it's used. The catheter is removed in the office, and most men find it much more comfortable than they anticipated. Most patients use a leg bag (strapped to the thigh, hidden under clothing) during the catheter period and adapt to it quickly.
Most patients are able to drive and resume light activity within 1–2 weeks after surgery, while the catheter is still in place. Avoid long car trips in the first week, and never drive while on narcotic pain medication. Most people manage desk work and light daily activity normally during the catheter period.
