By Dr. Héctor Ajubita Fernández - Urology Specialist. GUA Urology and Andrology.

Urethral stricture: a complete guide to understanding and treating it

Table of Contents

1. What is urethral stricture and why does it matter?
2. Symptoms and how it affects day-to-day life
3. Diagnosis: what tests do we perform
4. Treatments: from the simple approach to reconstruction
5. Frequently asked questions
6. Practical tips while waiting for the appraisal
7. How we accompany you in GUA
8. Make an appointment today

What is urethral stricture and why does it matter?

The urethral stricture is more than a narrowing of the urinary tract: it can significantly alter the quality of life. When pain, difficulty urinating or the sensation of incomplete emptying occurs, routine changes completely. Early detection and treatment prevents complications such as infections, urinary retention or progressive damage to the bladder and even the kidneys. The earlier you consult, the simpler the solution is usually.

Symptoms and how it affects day-to-day life

• Weak or broken stream, straining to urinate, stinging and dribbling.
• Recurrent urinary tract infections and sensation of incomplete emptying.

In addition to the physical aspect, many patients describe social limitations (constantly looking for toilets), anxiety about the possibility of retention and discomfort in their intimate life. Our approach seeks to restore your quality of life, not just "fix the urethra".

Diagnosis: what tests do we perform

At the first visit we explain each step to you. We use safe and well-tolerated tests to confirm the diagnosis and plan the best treatment:

• Uroflowmetry: measures the strength and quantity of the jet.
• Urological ultrasound: evaluates bladder and rules out complications.
• Retrograde urethrography: shows narrowing.
• Urethrocystoscopy: direct vision of the urethra with a flexible camera; it is performed under local anesthesia and the diagnosis is immediate. It is usually completed in minutes.

The objective is always to confirm the diagnosis in order to decide the most effective option in your case.

Treatments: from the simple approach to reconstruction

There is no universal treatment; we individualize each case. These are the most frequent options:

Urethral dilatations

Ambulatory procedure useful in mild stenosis. If it fails or the stricture recurs, more definitive alternatives should be considered.

Endoscopic internal urethrotomy

Minimally invasive technique that incises the narrowing from the inside, with endoscopic scalpel or laser. It is usually recommended in initial cases, congenital or with little fibrosis.

Paclitaxel Balloon Catheter Dilatation (OPTILUME)

A novel procedure that can be combined with urethrotomy in the same procedure. Paclitaxel reduces postoperative fibrosis and improves results, also on an outpatient basis.

Reconstructive surgery (urethroplasty)

Recommended in complex or recurrent stenosis. It offers the highest success rates and long-lasting results. In men with short strictures that do not affect the penile urethra, end-to-end anastomosis (resection of the diseased segment and joining the ends) can be performed. In long strictures or strictures that affect the penile urethra and in women, enlargement urethroplasty with buccal mucosa grafts (cheek, tongue or lip) is chosen. Two-stage surgeries are reserved for complex cases.

At GUA Urology and Andrology we have experience in urethral reconstructive surgery to offer definitive solutions in severe or recurrent strictures.

Frequently asked questions

Can urethral stricture recur?

Yes, it can in some cases. That is why regular follow-up after treatment is key.

Is the treatment painful?

The techniques are performed under anesthesia and are usually painless. The postoperative period is usually well tolerated, with progressive recovery.

Can it affect sex life?

After successful treatment, it is usual to resume a normal sex life. At GUA we also attend to this aspect to offer peace of mind and confidence.

Practical tips while waiting for the appraisal

• Adequate hydrationlimit bladder irritants (alcohol, excessive coffee).
• Do not delay urination when the desire arises.
• In case of fever, severe pain or inability to urinate, consult urgently.

Important: these tips are not a substitute for medical evaluation. Urethral stricture always requires evaluation by a specialist.

How we accompany you in GUA

At GUA Urology and Andrology we offer a confidential, close and decisive environment. We perform the complete study (uroflowmetry, ultrasound, urethrography, endoscopy), indicate the most appropriate treatment -from outpatient options to reconstructive surgery- and plan the follow-up to prevent relapses.

• Meet our team
• More content for your urological health

Make an appointment today

Take the next step towards your wellness. Schedule your assessment with our specialists in Gran Canaria:

• Phone: 928 264 695
• Email: info@urologiayandrologia.com
• Book your appointment online

"Your urological health deserves specialized care. We're here to help."

By Dr. Héctor Ajubita Fernández - Specialist in Urology and Andrology. GUA Urology and Andrology.

Table of Contents

1. What is the pudendal nerve?
2. Functions of the pudendal nerve in males
3. Pudendalgia: symptoms and warning signs
4. Diagnosis: Nantes criteria and available tests
5. Treatments for pudendal nerve entrapment
6. Impact on male quality of life
7. How we help you at GUA Urology and Andrology
8. Frequently asked questions
9. Request an appointment

What is the pudendal nerve?

The pudendal nerve is one of the most important nerves in the male pelvic floor.
It originates from the sacral roots S2–S4 and runs through the pelvis, passing through critical areas such as Alcock's canal.
Along this path, it can suffer irritation, inflammation, or entrapment, causing pain and functional disorders known as pudendalgia.

Despite its importance, it remains a great unknown: many men suffer for years from pelvic pain or sexual problems without reaching an accurate diagnosis.

Functions of the pudendal nerve in males

The pudendal nerve serves several key functions:

• Sensitive: provides sensitivity to the penis, scrotum, perineum, anus and urethra.
• Motor: controls essential muscles such as the external urethral sphincter and the anal sphincter.
• Autonomic: involved in erectile function and ejaculation.

Therefore, when this nerve is compromised, the symptoms affect not only the male pelvic floor,
but also the sexual and urinary spheres.

Pudendalgia: symptoms and warning signs

Entrapment of the pudendal nerve causes a set of very characteristic symptoms. Recognizing them is key in order not to confuse them with other urological pathologies.

Pelvic pain

• Discomfort or severe pain in the perineal area.
• Pain increases with sitting and improves with standing or sitting on the edge of the chair.
• It may coexist with foreign body sensation in the urethra or rectum.

Urinary symptoms

• Urinary urgency and need to urinate frequently.
• Pain or stinging when urinating (dysuria).
• Sensation of incomplete emptying of the bladder.

Sexual alterations

• Erectile dysfunction, sometimes resistant to conventional drugs.
• Painful ejaculation or discomfort during sexual intercourse.

This condition is often confused with chronic prostatitis,
which delays correct diagnosis and treatment.

Diagnosis: Nantes criteria and available tests

Diagnosis is based on the Nantes criteria, a set of clinical points that help identify pudendal neuralgia:

• Pain that worsens when sitting.
• Absence of pain during the night.
• Pain that does not radiate outside the pudendal nerve territory.
• Significant improvement after an anesthetic pudendal nerve block.

Imaging tests can provide information, but the most reliable confirmation is a positive response to a diagnostic block.

Treatments for pudendal nerve entrapment

Treatment is usually staggered, with less invasive options being sought first:

• Conservative measures: pelvic floor physiotherapy, postural changes, decompression exercises.
• Pharmacological treatment: neuromodulatory drugs for neuropathic pain.
• Anesthetic blocks: applied with ultrasound or radiological control, they provide relief and confirm the diagnosis.
• Neuromodulation: electrical stimulation of sacral roots or the pudendal nerve itself.
• Decompression surgery: indicated only in selected and refractory cases.

Impact on male quality of life

Chronic pelvic pain and pudendal nerve dysfunction affect men's personal, sexual, work, and emotional lives.
Early diagnosis is essential to avoid years of suffering and improve quality of life.
The good news: effective treatments are available.

How we help you at GUA Urology and Andrology

At GUA Urology and Andrology, in Las Palmas de Gran Canaria, we have a team specializing in male pelvic floor dysfunction.
We take a comprehensive approach: we combine accurate clinical diagnosis, advanced testing, and pelvic physiotherapy, tailoring each treatment to the individual case.

Meet us: our medical team.

Frequently asked questions

• Can pudendal nerve entrapment be cured? Many patients achieve significant improvement with physical therapy, blocks or neuromodulation.
• Is it the same as chronic prostatitis? No. Although they share symptoms, the cause and treatment are different.
• How long does it take to improve? It depends on each case and the time of evolution. Early detection facilitates recovery.

Request an appointment

If you suffer from pelvic pain or sexual dysfunction that could be related to the pudendal nerve, don't wait any longer.
Our team can help you regain your quality of life:

• Phone: 928 264 695
• Email: info@urologiayandrologia.com
• Make an appointment online

"Your pelvic and sexual health deserves specialized care. We're here to help you."