Posterior urethral stenosis is scarring or narrowing of the deepest part of the urethra, near the prostate and bladder outlet. It's different from an ordinary stricture: it usually follows a pelvic fracture, prostate cancer treatment, or prior prostate surgery, and the repair is more involved.

Common causes

• A pelvic fracture that tears the urethra (often from a car or motorcycle accident or a fall)

• Radical prostatectomy, where the bladder and urethra are reconnected

• Radiation for prostate cancer

• Prior prostate procedures such as TURP

What you might notice

A weak or spraying stream, straining, a feeling of not emptying, repeated infections, or not being able to urinate at all. After a pelvic fracture, many men already have a suprapubic tube (a catheter through the lower belly) when they first see me.

How I evaluate it

The goal is a clear map of the scar: where it starts and ends, how long it is, and how the bladder neck looks. That usually means a retrograde urethrogram, which I do in the office, often combined with a study through the suprapubic tube, plus cystoscopy and sometimes an MRI. Your bladder function and continence matter too, because they shape the plan.

Treatment

Short, mild narrowing can sometimes be managed endoscopically. Most pelvic fracture injuries need an open repair that removes the scar and reconnects healthy ends of the urethra. After prostate cancer treatment, the plan depends on whether you're also leaking: some men need the narrowing fixed first and an artificial urinary sphincter later.

Recovery

After an open repair you go home with a catheter, usually for about three weeks, and an X-ray dye study confirms healing before it comes out. Follow-up flow tests and cystoscopy check that the repair stays open.

Related

Urethral strictures overview · Urethroplasty recovery and catheter care · Suprapubic tube care