Weak Urine Stream? It Might Be a Urethral Stricture, Not Your Prostate

When a man notices his urine stream getting weaker, the prostate usually takes the blame. An enlarged prostate is common with age, and it does cause many urinary symptoms. But it isn't the only cause. A narrowing in the urethra, called a urethral stricture, can cause very similar problems and needs a different kind of treatment.

At our practice in Philadelphia, Paul H. Chung, MD, FACS, a fellowship-trained reconstructive urologist, specializes in diagnosing and repairing urethral strictures for men throughout the Philadelphia area, New Jersey, and Delaware.

What is a urethral stricture?

The urethra is the tube that carries urine from the bladder out of the body. A stricture is a section of that tube that has narrowed because of scar tissue. The narrowing makes it harder for urine to pass, much like a kink in a garden hose.

Common causes include:

Injury to the groin or pelvis, such as a straddle injury from a fall or bike accident
Previous catheters or procedures through the urethra
Past infections or inflammation
Prior prostate surgery or radiation
Skin conditions such as lichen sclerosus

Sometimes no clear cause is ever found.

Stricture or prostate? How the symptoms compare

Both conditions can cause a weak or slow stream, straining to urinate, a feeling that your bladder isn't empty, and frequent trips to the bathroom. A few clues point toward a stricture:

Symptoms that start at a younger age, before prostate enlargement is common
A spraying or split stream
A history of a catheter, injury, or urologic procedure
Repeated urinary tract infections
Prostate medications that don't help

That last point matters. Medications for an enlarged prostate relax or shrink the prostate. They do nothing for scar tissue in the urethra. If you've tried them without relief, a stricture may be the reason.

How strictures are diagnosed

A stricture can usually be found with simple tests. These may include a urine flow test, a bladder scan to check how well you empty, a special X-ray of the urethra, or a quick look inside with a small camera. These tests show where the stricture is and how long it is, which guides treatment.

Treatment options

Dilation or incision. Stretching or cutting the narrowed area can bring quick relief. However, strictures often come back after these procedures, especially when they're repeated.

Drug-coated balloon. For certain strictures, a balloon coated with medication can open the narrowing and help keep scar tissue from re-forming.

Urethroplasty. This reconstructive surgery removes or repairs the scarred section of the urethra. It has the highest long-term success rate and is often the best option for strictures that have come back or are long or complex. Dr. Chung performs urethroplasty as a core part of his reconstructive practice.

Don't ignore a weak stream

Left untreated, a stricture can lead to infections, bladder damage, bladder stones, or being suddenly unable to urinate. Getting the right diagnosis early gives you the most options. If you’re struggling with a urethral stricture, Dr. Chung can find the cause. To schedule a consultation, call our Chestnut Street office at 215-234-7885 or our Crescent Drive office at 215-234-3787, or book an appointment online.