Urethral stricture CAUSES The common causes of urethral stricture are: * Inflammatory * Secondary to urethritis * Secondary to balanitis xerotica obliterans (BXO) * Traumatic (MC) * Bulbar urethral injury * Pelvic fracture urethral disruption injury * Iatrogenic * Secondary to urethral instrumentation including cath- eterisation and transurethral prostatectomy * Secondary to radical prostatectomy * Secondary to radiotherapy for prostate cancer * Idiopathic CLINICAL FEATURES Symptoms are usually hesitancy of micturition, straining to void and a poor urinary stream. The relative youthfulness of the patient often rules out prostatic enlargement, which characteristically occurs after the age of 50. As the stream becomes narrower, micturition is prolonged and is followed by postmicturition dribbling as a result of urine trickling from the dilated urethra proximal to the stricture. Urinary frequency by day and night is common and is due to incomplete bladder emptying, coexisting detrusor overactivity or urinary infection. If the stricture is tight enough, the patient will go into acute retention, although this is rare. If this happens, there is a danger that clumsy attempts to pass a urethral catheter will result in a false passage. If a patient has gone into retention because of a urethral stricture, its lumen will be too narrow to pass even a tiny catheter and suprapubic catheterisation is required. Investigation involves uroflowmetry, urethroscopy, urethrography and ultrasound scanning to assess bladder emptying and to detect any upper tract dilatation. The urinary flow rate is typically prolonged and plateau shaped while urethroscopy allows the stricture to be viewedas a circumferential scar. Openings of false passages commemorate previous misguided attempts to pass a urethral catheter. Urethrography using a water-soluble contrast medium will show the extent and severity of the stricture Ref: Bailey and love 27th edition Pgno : 1482