Poor urine flow can be due to obstruction to flow such as a stricture urethra (narrowing in the urine tube) or prostatic enlargement. Occasionally this can be due to weak bladder musculature.

Stricture urethra is a narrowing in the urine tube (urethra) and decreases the urine flow with increased frequency of urination (due to inadequate bladder emptying). Stricture urethra can occur due to lichen sclerosis (a skin disorder affecting the external genitalia), infection, trauma, instrumentation, radiation treatment for prostate cancer or as a result of poor catheterization technique.

Diagnosis of stricture urethra is achieved by performing a retrograde urethrogram (X-ray taken after instilling a small amount of contrast in the urethra) and/or a voiding cystourethrogram (patient is made to pass urine after filling the bladder with contrast and an X-ray is taken). Another method is on visualization of the stricture on direct inspection with a telescope (cystoscopy).

This depends on the cause, location, length of the stricture and the surrounding fibrosis.

The available options include –

1. Dilatation or urethrotomy – this procedure aims to stabilize the urethral size by stretching the narrow portion or cutting into the narrow portion.

2. Urethroplasty – this is a definitive procedure to augment the urethral lumen and is used in cases where the stricture recurs after dilatation or urethrotomy.

Various types of urethroplasty procedures are used to treat stricture urethra –

• Augmented anastomoses –
  • Dorsal onlay
  • Ventral onlay
  • Dorsal inlay
  • Ventral inlay
  • Double face
  • Flaps
• Substitution anastomoses –
  • Pedicled preputial tube
• Anastomotic urethroplasty
• Non transecting anastomotic urethroplasty
• Augmented anastomotic urethroplasty
• Perineal urethroplasty

The exact nature of surgery needs to be discussed with our Urologist.