Urethral Strictures

Urethral strictures in children have the potential to contribute to recurring urinary tract infections, bladder problems, or issues with kidneys if urine is not able to fully or properly flow and be eliminated. If it is suspected that a child’s symptoms are related to a urethral stricture, a referral to a pediatric urologist should be made. Urethral strictures in children are generally due to previous urethral injury or surgery.

The most common symptom associated with scar tissue formation in the urethra is noticeable changes in urination patterns. For some children, this means a reduced urine flow or an inability to fully empty the bladder. Children with urethral strictures may also experience:

• Urine spraying due to an inability to control the direction of urine
• Pain felt in the abdominal or pelvic area
• Frequent urinary tract infections
• Blood in urine (hematuria)
• Penile swelling from urine buildup or urethra irritation
• A feeling of having to urinate again shortly after having gone to the bathroom if the bladder is not fully emptied the first time

• Following an initial physical examination, a uroflow test and possibly a catheter X-ray test will be performed to make a diagnosis of a urethral stricture. Additionally, a cystoscopy may be performed where a special lighted scope is  inserted into the urethra to look for signs of scar tissue or abnormal narrowing. This scope can also be used to evaluate the bladder to look for additional issues related to urine flow problems.
• A urinalysis may be done to determine if there is an infection or possible kidney problems.
• A post-void residual study is generally performed to see how much urine is left in a child’s bladder after they urinate.

• Antibiotics may be needed to treat any existing urinary tract infections a child may have because of urethral strictures.
• Otherwise, treatment may involve a surgical procedure that opens the scarred area. Generally, small stricture areas may be treated with a cystoscopy with a urethrotomy performed through the cystoscope.
• If there is a long urethral stricture or repeated urethral stricture, it will be necessary to remove scar tissue in the urethra is with an open urethroplasty. With open urethroplasty, the scarred part of the urethra may need to be surgically reconstructed with graft material (anastomotic urethroplasty).
• If urethral strictures have severely damaged a child’s urethra, an artificial opening may be created in the abdomen for urine with a surgically created tube using the appendix or a part of the bowel to allow the bladder to be drained intermittently by a catheter and bypassing the scarred urethral altogether.