Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Initial investigations to confirm a diagnosis of urethral stricture include:
- A thorough clinical history and physical examination focusing on lower urinary tract symptoms and examination of the external genitalia and abdomen, as well as a digital rectal examination to assess for other causes of obstruction. This is part of the initial assessment for men with LUTS and suspected urethral pathology. NICE CG97
- A urine dipstick test to detect blood, infection, or other abnormalities that may suggest complications or alternative diagnoses. NICE CG97
- Referral for specialist assessment if symptoms are bothersome or complicated, where further investigations such as uroflowmetry (flow rate measurement), post-void residual volume measurement, and cystoscopy may be performed. However, these are not routinely done at initial assessment but rather at specialist evaluation. NICE CG97
- Cystoscopy is the definitive investigation to confirm urethral stricture, but it is reserved for specialist assessment and is indicated when there is a history of recurrent infection, haematuria, or profound symptoms. NICE CG97
Therefore, at the initial general practice level, the focus is on history, physical examination, and urine dipstick testing, with referral to urology for cystoscopy and flow studies to confirm urethral stricture.