What are the key clinical features that suggest a diagnosis of urethral stricture in a male patient?

Key clinical features suggesting a diagnosis of urethral stricture in a male patient include:

• Lower urinary tract symptoms (LUTS): These commonly manifest as a weak or decreased urinary stream, hesitancy, straining to void, and a sensation of incomplete bladder emptying NICE CG97.
• Spraying or deviation of the urinary stream: This occurs due to narrowing of the urethral lumen causing turbulent flow Barbagli et al. 2004.
• Recurrent urinary tract infections (UTIs): Strictures can cause urinary stasis, predisposing to infections NICE CG97.
• Urinary retention or difficulty initiating urination: Patients may report episodes of acute urinary retention or difficulty starting to pass urine NICE CG97.
• Perineal or penile pain or discomfort: Some patients experience pain along the urethra or perineum, which may be chronic or intermittent Delavierre et al. 2010.
• History of urethral trauma, instrumentation, or infection: Previous catheterisation, urethritis, or trauma are important historical clues Zhivov et al. 2017.
• Palpable induration or fibrosis along the penile or perineal urethra: On physical examination, a firm or fibrotic segment may be felt, especially in cases related to lichen sclerosus Barbagli et al. 2004.

These features together raise clinical suspicion for urethral stricture and warrant further diagnostic evaluation such as uroflowmetry, urethrography, or cystoscopy [1, Zhivov et al., 2017].