Urethral stricture is a significant urological condition characterized by the narrowing of the urethral lumen. This narrowing obstructs the normal flow of urine and may lead to complications such as urinary retention, recurrent infections, and even kidney damage if left untreated. Understanding the anatomy, clinical manifestations, and nursing implications of urethral stricture is essential for effective patient assessment and care planning.
The urethra functions as the passage through which urine is expelled from the bladder. It contains two important sphincters: the internal urethral sphincter, composed of smooth muscle under autonomic control, and the external urethral sphincter, composed of striated muscle that allows voluntary control of urination. In adult males, the urethra is approximately 23–25 cm long and is divided into the anterior and posterior urethra, separated by the external sphincter.
What Is Urethral Stricture?
Urethral stricture is defined as the narrowing of the urethral lumen due to scarring, tissue fibrosis, inflammation, or trauma. The condition can occur anywhere along the urethra but is more commonly found in men due to their longer urethral length.
- Long (1996): Urethral stricture is a narrowing caused by obstruction of the urethral lumen.
- Smeltzer & Bare (2002): Urethral strictures result from chronic inflammation and contraction of urethral tissue.
- Long (1996): Strictures occur more frequently in men than women due to anatomical differences.
The condition can develop slowly and progressively, leading to significant impairment in urinary elimination. In severe cases, untreated strictures may result in complete urinary blockage, bladder distention, and increased pressure on the kidneys.
Causes and Risk Factors
Several factors can contribute to the development of urethral stricture:
- Trauma to the pelvis or perineum (e.g., accidents, sports injuries)
- Instrumentation such as catheter insertion or cystoscopy
- Sexually transmitted infections (STIs) such as gonorrhea
- Chronic inflammation or repeated urinary tract infections
- Urethral surgery or previous urological procedures
Clinical Manifestations of Urethral Stricture
Patients with urethral stricture may present with a variety of symptoms depending on the severity and location of the obstruction.
Common Signs and Symptoms
- Difficulty starting urination (hesitancy)
- Weak or slow urinary stream
- Spraying or branching urine stream
- Dribbling after urination
- Straining during urination
- Incomplete bladder emptying
- Burning sensation or pain during urination
- Recurrent urinary tract infections
Severe Symptoms
- Acute urinary retention
- Swelling of the scrotum or perineal area
- Purulent discharge (pus) from the urethra
- Hematuria (blood spots on underwear)
- Cloudy or foul-smelling urine associated with infection
According to Smeltzer (2002), symptoms usually begin with obstructed urinary flow and can progress to complete obstruction similar to bladder neck obstruction seen in prostatic hypertrophy. Inflammation-related strictures may develop at multiple locations along the urethra.
Complications of Urethral Stricture
If not treated early, urethral stricture may lead to:
- Recurrent UTIs
- Urethral abscess
- Bladder stones
- Urinary retention
- Hydronephrosis
- Kidney failure
Prevention of Urethral Stricture
Preventing urethral stricture involves minimizing risk factors and maintaining good urological health.
- Avoid trauma to the urethra and pelvis.
- Use proper technique during transurethral procedures such as catheterization.
- Practice safe sexual behavior to prevent STIs, especially gonorrhea.
- Seek early treatment for urethral infections to prevent complications.
Early management helps prevent long-term complications such as kidney damage and chronic urinary retention.
4 Nursing Diagnosis for Urethral Stricture
Nurses play a critical role in assessing symptoms, monitoring urinary patterns, and preventing complications. The following are four key nursing diagnoses commonly associated with urethral stricture:
1. Urinary Retention Related to Obstruction in the Urinary Tract
Obstruction caused by narrowing of the urethra leads to impaired bladder emptying. The patient may experience distended bladder, decreased urine output, and discomfort.
- Monitor bladder volume using palpation or bladder scanner.
- Encourage timed voiding to avoid overdistention.
- Prepare for catheterization if necessary, using sterile technique.
2. Acute Pain Related to Biological Wound (Ischemia)
The increased pressure and inflammation in the urethral tissue may cause pain or burning sensations during urination.
- Assess pain frequency, intensity, and triggers.
- Encourage increased hydration to reduce urine concentration.
- Administer analgesics as prescribed.
3. Risk for Infection Related to Inadequate Primary Defense
Obstructed urinary flow promotes bacterial growth, increasing the risk of urinary tract infections.
- Monitor urine color, odor, and clarity.
- Encourage proper perineal hygiene.
- Teach the patient about signs of infection such as fever or cloudy urine.
4. Impaired Urinary Elimination Related to Anatomic Obstruction
The inability to pass urine normally leads to altered urinary patterns and increased risk of urinary retention.
- Document urinary frequency and pattern.
- Assist the patient during voiding to prevent strain.
- Prepare for diagnostic procedures such as uroflowmetry or imaging.
Conclusion
Urethral stricture is a common urological condition that primarily affects men and results in significant urinary dysfunction. Early recognition of symptoms, comprehensive assessment, and evidence-based nursing interventions are essential in preventing complications such as infection, urinary retention, and kidney failure. By understanding the anatomy of the urethra, risk factors, clinical manifestations, and nursing diagnoses, healthcare professionals can provide optimal care for patients experiencing this condition.
LSI Keywords: urethral obstruction, urinary flow restriction, narrowing of urethra, male urethral anatomy, urinary complications, urinary retention causes.
References
- Long, C. Barbara. (1996). Medical-Surgical Nursing.
- Smeltzer, Suzanne C., & Bare, Brenda G. (2002). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
- Nursalam. (2008). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan.
- American Urological Association (AUA) Guidelines.
