Bulbar Urethral Stricture: Obstruction, Injury, Rupture, False Passage, Symptoms, and NHS Massage Guide
- What is Bulbar Urethral Stricture?
- Obstruction
- Injury
- Rupture
- False Passage
- Symptoms
- NHS Massage Guide
What is Bulbar Urethral Stricture?
A bulbar urethral stricture refers to a narrowing of the urethra that occurs in the bulbar segment — the portion of the urethra located between the penile and membranous parts. This condition typically results from scarring, inflammation, or trauma, which leads to restricted urinary flow. The bulbar urethra is a common site for strictures because it is susceptible to injury from catheterization, infection, or blunt perineal trauma.
Over time, a stricture can cause progressive urinary obstruction, making urination difficult and potentially leading to secondary complications like bladder distension, infections, or even renal impairment. Diagnosis is often made using retrograde urethrogram (RUG), cystoscopy, or ultrasound imaging. Treatment depends on the severity, ranging from minimally invasive dilation and urethrotomy to reconstructive urethroplasty for longer or recurrent strictures.
Obstruction
Urethral obstruction in bulbar stricture occurs when scar tissue narrows the lumen, impeding urine flow. The degree of obstruction can vary, with mild cases causing only reduced flow and severe cases leading to complete urinary retention. This mechanical blockage increases bladder pressure and can lead to urinary tract infections (UTIs), bladder wall thickening, and upper tract dilation if left untreated.
Patients often report symptoms such as straining to urinate, weak urine stream, and incomplete bladder emptying. Obstruction is confirmed through uroflowmetry or imaging, showing a reduced peak urinary flow rate and a characteristic narrow segment on urethrogram. Prompt management is important to prevent secondary complications, and interventions like dilation or urethroplasty can restore normal urinary function.
Injury
Injury to the bulbar urethra is a leading cause of stricture formation. It may occur due to catheter trauma, pelvic fracture, perineal impact (straddle injury), or iatrogenic damage during instrumentation. The healing process following injury can result in fibrosis and scar formation within the urethral wall, leading to persistent narrowing.
Prevention of iatrogenic injuries involves careful catheter insertion using adequate lubrication and correct technique. In cases where trauma is suspected, early assessment with imaging can prevent delayed diagnosis and long-term complications. Once fibrosis has developed, surgical repair is often required to restore urethral patency.
Rupture
A bulbar urethral rupture is a more severe form of urethral injury, typically associated with high-impact pelvic or perineal trauma. It involves a tear or complete disruption of the urethral continuity, leading to urinary leakage into surrounding tissues and possible hematoma formation. Patients often present with inability to urinate, perineal bruising, and blood at the urethral meatus.
Diagnosis is made through retrograde urethrogram, which reveals contrast extravasation. Management may involve primary realignment in acute settings or delayed urethroplasty after tissue healing. Post-traumatic ruptures frequently lead to stricture formation, making close follow-up essential to monitor for obstructive symptoms and ensure functional recovery.
False Passage
A false passage may occur when instrumentation, such as catheterization or dilation, is performed incorrectly and perforates the urethral wall. Instead of entering the bladder, the catheter creates an abnormal tract alongside the urethra. This complication can exacerbate scarring, worsen existing strictures, and increase the risk of infection or bleeding.
Recognition of a false passage is crucial, especially in patients with prior urethral disease. If suspected, catheterization should be stopped immediately, and imaging or cystoscopy should be used for confirmation. Proper training and use of hydrophilic or flexible catheters reduce the risk. In severe cases, surgical repair may be necessary to restore normal anatomy and prevent chronic obstruction.
Symptoms
Common symptoms of a bulbar urethral stricture include weak urinary stream, difficulty initiating urination, dribbling after voiding, and a sensation of incomplete emptying. Some patients also experience urinary retention, frequent urination, or discomfort during urination. Recurrent urinary tract infections are common due to stagnant urine and poor bladder emptying.
In chronic cases, visible complications such as perineal swelling or urinary fistula formation may develop. The severity of symptoms depends on the stricture length and degree of narrowing. A careful clinical evaluation, combined with uroflowmetry and imaging, helps determine the extent of the condition and guides treatment.
NHS Massage Guide
According to NHS post-procedural guidance, gentle perineal massage may sometimes be recommended after surgery or dilation to help improve local circulation and promote healing in the bulbar urethral area. The goal is to reduce tissue stiffness and improve comfort; however, massage should only be done if advised by a urologist or specialist nurse.
Patients should avoid applying pressure directly to the urethra or surgical site. Instead, gentle circular motions around the perineal region can aid comfort and reduce postoperative soreness. It’s essential to follow official NHS or clinical care instructions and to report any pain, swelling, or discharge immediately, as these may indicate infection or complications. Massage is not a treatment for strictures themselves but can complement recovery after medical intervention.
Reviewed by Simon Albert
on
July 24, 2025
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