Is male urethral stenosis hereditary?

Whether urethral stenosis is congenital depends on whether it is congenital. If it is congenital, it is caused by genetics or developmental malformation, including gene mutations. Because urethral stenosis can cause difficulty in urination and may even cause urine retention, urethral stones and urinary tract infections, it is necessary to make a good diagnosis of the condition.

Pathological etiology

1. Traumatic urethral stenosis Traumatic urethral stenosis is actually a late complication of urethral trauma. It is the most common, with bulbar urethral stenosis accounting for about 50%, followed by the posterior urethra at about 40%, and the penile urethra at least accounting for 10%. Traumatic injuries include penetrating injuries (gunshot, stabbing), blunt injuries (rider injuries, penile contusion) and compression injuries (pelvic fractures). The first two injuries are often prone to injuring the anterior urethra, and the latter injury can injure the posterior urethra in 10%, which is a shear injury of the membranous part or a tear between the bulbar and membranous parts, and there are often combined injuries. Some patients with straddle injuries did not seek medical treatment in time due to their minor injuries, and most of them developed urethral stenosis symptoms 5 to 7 years later. Some patients were not diagnosed until their condition required a urinary catheter.

2. Iatrogenic injuries are mostly located between the anterior urethra, scrotum, and penis junction to the bulbar urethra. They are caused by instrumentation in the urethra, urethral compression necrosis, or chemical stimulation from an indwelling urinary catheter. Recently, it has been found that pancreatic enzymes in urine after pancreatic transplantation can damage the urethral mucosa and cause urethral stenosis. Prolonged endoscopic operation is the main cause of iatrogenic urethral stenosis. When an indwelling urinary catheter is used, in addition to the chemical toxicity of the catheter, bacteria easily adhere to the surface of the catheter, causing retrograde infection. Compression of the catheter at the physiological bend causes ischemic necrosis, which can easily cause stenosis.

3. Inflammatory Inflammatory urethral stenosis is caused by specific or non-specific urethral infection. Among specific infections, urethral stenosis caused by gonorrhea is more common, followed by tuberculosis; among non-specific infections, urethral stenosis of the external urethra and penile urethra caused by repeated foreskin inflammation is more common. Recurrent gonorrheal urethritis causes extensive scar tissue to form on the urethral wall, which can present as segmental or long-segment urethral stenosis. The scar penetrates into the entire urethra and even the surrounding tissues of the urethra, causing urethral lumen obstruction, which is very difficult to treat clinically.

4. Congenital: Congenital stenosis of the external urethral orifice is the most common, and urethral valves, hypertrophy of the seminal vesicles, congenital narrowing of the urethral lumen, phimosis, etc. may also be seen.

Urethral stricture can be divided into simple urethral stricture and complex urethral stricture according to the length of the stricture and the presence or absence of complications. Complex urethral stricture includes: the length of the stricture exceeds 3cm in the anterior urethra and exceeds 2cm in the posterior urethra; more than two stricture segments; accompanied by stones, diverticula, inflammatory polyps, urethritis or periurethritis; chronic urine leakage, accompanied by the presence of a false passage; urethral sphincter dysfunction; severe pelvic deformity or concurrent pubic osteomyelitis and high urethral stricture close to the bladder neck.