How to diagnose a urethral stricture?

Often, the GP and urologist already suspect a stricture because of the described discomforts, such as a weakening urine flow and a trickle of residual urine after voiding. The diagnosis of urethral stricture can be secured with specific examinations:

The pressure-flow-measurement is a traditional examination and requires an observation of the urine flow during voiding. This examination can narrow down the possible causes for a weaker urine stream since the stream behaves always in the same way when a urethral stricture presents itself. The doctor can also get clues for the potential presence of benign hyperplasia of the prostate.

An experienced doctor can use sonography to recognize changes in the bladder or urethral region in an ultrasound image. That is not just the case for strictures of the urethra, but also for a hypertrophied, meaning thickened, bladder. An advantage of ultrasound examinations is the fact that potential residual urine after voiding becomes visible.

Ultrasound diagnostics often entail an x-ray that shows the urethra with a contrast agent. This is the so called retrograde urethrography. Presenting cavities on an x-ray allows for the real extend of strictures to become visible. The disadvantage of this examination, however, is that changes – for example changes in the urethral region around the stricture that are caused by bladder pressure cannot be captured. Especially when planning surgery, a voiding cystourethrogram is prepared: This dynamic examination method captures the urethra and the bladder in the moment of voiding.

Endoscopic examinations allow a direct look at the stricture inside the urethra. This happens with the help of a thin and flexible endoscope. At its top sits a tiny camera that delivers immediate images to the doctor’s screen. The invasive endoscopy usually takes place under local anesthesia of the urethra and normally only happens when further ambiguity remains after previous examinations.

To recognize and treat infections in a timely manner – especially relating to the kidneys – other examinations are of importance. Thorough diagnostics of urethral strictures include blood and urine examinations.