Which initial investigations should be performed to confirm a diagnosis of urethral stricture?

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. ¹
• A urine dipstick test to detect blood, infection, or other abnormalities that may suggest complications or alternative diagnoses. ¹
• 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. ¹
• 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. ¹

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.