Urethral Stricture
A.  Urethral stricture
B.  Dilated posterior urethra
C.  Trabeculated bladder
C A B Post-traumatic urethral strictures most commonly occur within the mobile anterior male urethra at its junction with the fixed membranous urethra (usually straddle injury against the adjacent ischium). With healing of the the urethral epithelium and underlying corpus spongiosum, fibrosis and contraction leads to scarring and reduced urethral luminal diameter (spongiofibrosis). Subtle urethral strictures often remain relatively asymptomatic. More severe stenoses results from progressive fibrosis and resultant contraction of soft tissues. Though the posterior urethra is less commonly injured than the anterior urethra, traumatic urethral distraction injury can lead to focal posterior urethral fibrosis as well. Urethral strictures however are usually are confined to a short segment. Patients who have urethral stricture most often present with obstructive voiding symptoms such as terminal hematuria, pain , burning, hesitation or urinary tract infections. Retrograde urethrography is performed as the initial evaluation of stricture location and length. VCUG can also be done in cases of less severe stricture. Ultrasound can be used as an adjunct imaging modality to determine depth and density of fibrosis, though the absolute length of spongiofibrosis may not be evident. Endoscopic evaluation may be necessary after contrast studies to further define stricture anatomy. In select patients, it may be necessary to place a suprapubic catheter to defunctionalize the urethra. Treatment often consists of periodic dilatations or surgery, including internal urethrotomy. Urethral stricture, post-traumatic Campbell’s Urology, 8th Ed. Pp. 3915-3920.