Urethral Obstruction: Symptoms, Causes, and Treatment

Urethral obstruction (narrowing of the urethra or upper urinary tract) is a significant urological condition that slows down urine flow, reduces quality of life, and may threaten kidney health.

What Is Urethral Obstruction?

A narrowing or complete blockage at any point in the urinary tract prevents urine from exiting the bladder. It is more common in men due to their longer urethral anatomy; in women, it usually occurs after pelvic surgery. Causes include trauma, infection, stones, tumors, or congenital anomalies.

Who Is at Risk?

Primary risk factors that increase the likelihood of obstruction include:

• History of urethral trauma (accidents, pelvic fractures)
• Previous urological procedures (catheterization, cystoscopy, prostate surgery)
• Recurrent sexually transmitted infections
• Kidney or bladder stones
• Pelvic region radiotherapy
• Congenital urethral strictures

What Are the Symptoms?

As the severity of the obstruction increases, symptoms become more pronounced:

• Weak or intermittent urine stream
• Straining or difficulty during urination
• Sensation of incomplete emptying, dribbling
• Frequent urination or sudden urgency

• Hematuria (blood in urine) or burning due to infection
• Advanced cases: flank pain, nausea, and fever

Early diagnosis is critical in preventing kidney function loss.

How Is It Diagnosed?

Accurate diagnosis is essential for proper treatment planning:

• Physical examination and medical history: Past surgeries and infection history are evaluated.
• Uroflowmetry: Measures the speed of urine flow.
• Ultrasound: Detects bladder or kidney enlargement.
• Retrograde urethrography or voiding cystourethrography: Locates and measures the stricture.
• Endoscopic evaluation: Allows direct visualization and simultaneous planning for intervention.

What Are the Treatment Options?

Treatment depends on the location, length of the stricture, and the patient’s overall health.

Conservative Approaches

Observation and infection control may be sufficient in short, minimally symptomatic cases.

Endoscopic Dilation and Urethrotomy

The narrowed segment is dilated using a balloon or bougie; it may be incised with a laser or cold knife. While recurrence risk exists, it is the first-line option for short strictures.

Interventional Radiology Techniques

In addition to traditional surgical options, interventional radiology provides minimally invasive image-guided procedures that quickly relieve symptoms and shorten recovery time.

Radiologists use ultrasound, fluoroscopy, or CT guidance to access the urinary tract through millimeter incisions. The goal is to bypass, drain, or open the obstruction. These techniques reduce the need for general anesthesia, shorten hospital stay, and often allow same-day mobilization.

Percutaneous Nephrostomy: A catheter is inserted into the renal pelvis through the skin to immediately drain urine and relieve pressure.

Antegrade Ureteral Stenting: A double-J stent is placed through the nephrostomy into the ureter, temporarily bypassing the stone or stricture.

Balloon Dilation: A balloon catheter is inserted at the stricture site under fluoroscopy to enlarge the ureter/urethra lumen.

Endoureterotomy / Endourethrotomy: The narrowed segment is incised using a laser or cold knife, often combined with balloon dilation or stenting.

Biodegradable Stents: New-generation polymer stents dissolve over time, eliminating the need for a second procedure.

Combined Stone Management: Percutaneous nephrolithotomy (PNL) and nephrostomy are performed in a single session to both remove stones and restore drainage.

Reconstructive Surgery (Open or Robotic)

Anastomotic Urethroplasty: For strictures under 2 cm, the narrowed segment is removed and the ends are reconnected.
Substitutional Urethroplasty: In longer strictures, oral mucosa grafts are used for reconstruction.

Surgery often provides a permanent solution, restoring normal urine flow and kidney function.

Complications and Quality of Life

Untreated obstruction can lead to recurrent urinary tract infections, bladder stones, hydronephrosis, and kidney failure. Regular follow-up improves quality of life and reduces complications.

Prevention and Healthy Lifestyle Tips

• Protection against sexually transmitted infections
• Early treatment of infections
• Urological evaluation after trauma
• Drinking plenty of water and maintaining a healthy diet
• Regular kidney-bladder ultrasound screening (for high-risk groups)