Stricture

A stricture is a narrowing of the urethra caused by scar tissue. After urethral lengthening, a stricture means a section of the new urethra has tightened enough to slow or block the stream. It is one of the two urethral complications, with fistula, that every bottom surgery page warns about.

Where does a stricture happen?

A stricture forms wherever the new urethra was stitched or had a thin blood supply, because scar is how the body heals a join and scar pulls the tube inwards. The usual sites are the join between the new urethra and your original urethra, and the join between the two sections of a phalloplasty urethra if it was built in parts. A narrowing at the tip is also called a meatal stenosis; for planning purposes it is the same problem.

A stricture is a risk of urethral lengthening in either phalloplasty or metoidioplasty. A simple release or a phalloplasty without a urethra carries no stricture risk, because the original urethra is left alone.

How does a stricture show up?

A stricture shows up as a stream that weakens over weeks or months, usually from about month three onwards: thinner, slower, needing a push, taking longer to empty, dribbling after you finish. A fistula announces itself with urine in the wrong place; a stricture creeps up, which is why the recovery timelines on the procedure pages tell you to watch your stream. It is what people on forums mean when they say their stream "went off" months after they thought they were done.

How common is a stricture?

A stricture is common rather than rare. Published series for phalloplasty with urethral lengthening put fistula and stricture together somewhere between a quarter and a half of patients, and strictures are a fair share of that. Metoidioplasty urethras are shorter and built from tissue that has not been moved far, so their rates are lower, but urethral trouble is still the main complication in meta. The range is wide because technique, staging and surgeon volume vary.

How is a stricture diagnosed?

A stricture is confirmed with a flow test, sometimes a camera into the urethra, sometimes an X-ray with contrast. The surgeon will check for a fistula at the same time, because a stricture raises the pressure behind the narrowing and can open one.

How is a stricture treated?

A short, soft stricture is stretched with dilation, either once by the surgeon or as something you learn to do yourself for a while. A longer or tougher stricture needs a revision, in which the narrowed section is opened and widened, sometimes with a graft such as lining from inside the cheek. Surgeons wait until the tissue has settled, typically around six months from the operation that caused it, so the revision is planned rather than an emergency.

Repairs mostly work. Strictures come back more often than fistulas do, so a second attempt is not unusual. In a small minority the urethra never becomes reliable and the opening is moved back to the perineum; that is safe, keeps the phallus, and is worth knowing about before you commit to lengthening.

What does a stricture mean for the plan?

A stricture means another procedure, another recovery, and a period of sitting to pee again. Dilation or a revision appears in quotes as an extra unless the surgeon includes repairs, and in the US each revision usually needs its own insurance authorisation.

What to ask the surgeon

Ask for the stricture rate separately from the fistula rate, for your technique, at a year. Ask whether dilation and revision are in the quote, how many revisions they typically need to reach a reliable stream, and what share of their patients are standing to pee at a year without planning to sit. Stopping nicotine matters for every join in the body; the eligibility section covers that.

← Back to the Glossary