What Is Urethral Stricture in Women?

Urethral stricture in women is a permanent narrowing that forms in a section of the channel (urethra) through which urine exits the bladder. Due to this narrowing, urine cannot flow freely and the person feels as though there is a "blockage."

In simple terms: The inside of the urinary canal constricts and narrows. This condition is far less common in women than in men, which is why it often goes undetected for a long time or is confused with other diseases.

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How Does Urethral Stricture Develop in Women?

Urethral stricture typically develops due to scar (cicatrix) tissue that forms on the inner surface of the canal. This scar tissue is not flexible and gradually narrows the canal over time.

Most common causes:

• Frequent catheterization in the past

• Endoscopic procedures

• Recurrent infections

• Previously failed interventions

• Rarely, congenital narrowing

In plain patient terms: "The canal becomes irritated, and as it heals, it shrinks and narrows."

 

Which Conditions Is It Confused With?

Urethral stricture in women is very frequently confused with the following conditions:

• Overactive bladder

• Recurrent urinary tract infections

• Pelvic floor muscle problems

• Painful bladder syndrome

• Bladder neck stricture

For this reason, many patients spend years hearing:

"I took medication but it didn't help" "It was constantly assumed to be an infection" "I was told it was psychological"

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Symptoms of Urethral Stricture in Women

Most commonly seen complaints:

• Difficulty initiating urination

• Weak and intermittent urine flow

• Feeling of incomplete bladder emptying

• Frequent urinary tract infections

• Residual urine in the bladder

• Sometimes pain and burning

Most typical statement: "I urinate but I don't feel relieved."

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How Is the Diagnosis Made?

The diagnosis is not made with a single test, but through the combined evaluation of several pieces of information:

• Patient history and physical examination

• Urinalysis and ultrasound

• Urine flow test (uroflowmetry)

• Cystoscopy (camera examination) when necessary

• Urodynamics in some patients

But most importantly:

Complaint + weak urine flow + residual urine in the bladder → stricture is suspected.

 

Treatment Options

The fundamental question in treatment is: "Are we looking for temporary relief, or a permanent solution?"

1. Dilation (Widening)

The urethra is temporarily widened using special instruments.

Advantages:

• Simple and fast

• Can be tried for a short stricture detected for the first time

Disadvantages:

• High likelihood of recurrence

• If repeated multiple times, the tissue becomes even more rigid

• Low probability of being a permanent solution

In patient terms: "It opens up, but narrows again."

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2. Drug-Coated Balloon

The narrowed area is opened with a balloon while simultaneously delivering a drug aimed at reducing scar formation.

However, the reality in Turkey:

• Not covered by SGK (Social Security Institution)

• High cost

• Long-term scientific data in women is limited

For this reason: This is not a routine standard treatment. It is an option that may be considered in selected patients at specialized centers.

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3. Urethroplasty (Permanent Reconstructive Surgery)

The goal of this surgery is: Not to forcibly open the stricture, but to rebuild the narrowed area with healthy tissue.

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Our Center's Special Method:

AZ Technique (Aybek–Zümrütbaş Technique)

This technique is a specialized urethroplasty method developed at our center for recurrent urethral stricture in women and published in scientific journals.

How Is the AZ Technique Performed? (In Patient Terms)

• A very small piece of tissue is taken from inside the mouth

• This tissue is added like a patch to the narrowed area of the urinary canal

• The canal widens and becomes flexible

In other words: "A new and healthy lining is added to the inside of the narrowed tube."

There is no permanent scarring in the mouth, and speaking and eating are not affected.

What Do the Scientific Results Show?

In studies published by our center:

• All patients had previously undergone multiple failed procedures

• After surgery, urine flow increased 4–6 times

• Residual urine in the bladder was reduced to nearly zero

• No urinary incontinence occurred

• No serious complications were observed

And most importantly:

In the comparative study:

• Success with classical techniques: 83–87%

• Success with the AZ Technique: >90% (At an average follow-up of 2 years)

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Advantages of the AZ Technique

Clear advantages for the patient:

• Aims for a permanent solution

• Low likelihood of recurrence

• Very low risk of urinary incontinence

• Vaginal tissue is preserved

• No foreign material is placed in the body

• High probability of being a one-time solution

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Which Treatment Makes Sense for Which Patient?

Situation - Recommended Approach

First occurrence, short stricture - Dilation can be tried

Constantly recurring - Urethroplasty is more reasonable

Seeking a permanent solution - AZ Technique

Does not want surgery - Drug-coated balloon (with awareness of cost)