Bulbar urethral stricture is a medical condition that affects the urethra, particularly the bulbar segment, which is located in the middle portion of the male urethra. This condition occurs when scar tissue or narrowing develops in this area, leading to difficulty with urine flow, urinary retention, and sometimes pain. Bulbar urethral strictures can result from trauma, infection, or iatrogenic causes such as catheterization or surgery. Understanding how this condition is classified in the ICD-10 coding system is important for accurate documentation, treatment planning, and billing in clinical practice.
What is a Bulbar Urethral Stricture?
A bulbar urethral stricture is a narrowing of the urethral lumen in the bulbar urethra. The urethra serves as the channel that carries urine from the bladder to the outside of the body, and any narrowing can impede urine flow. Patients with bulbar urethral stricture often present with weak urinary stream, spraying of urine, straining to void, incomplete emptying, and recurrent urinary tract infections. In severe cases, urinary retention may occur, requiring urgent medical intervention.
Causes of Bulbar Urethral Stricture
Several factors can contribute to the development of a bulbar urethral stricture. The most common causes include
- TraumaInjury to the urethra from pelvic fractures, straddle injuries, or external trauma can lead to scar formation and narrowing.
- InfectionsRecurrent urinary tract infections, sexually transmitted infections, or urethritis can cause inflammation and fibrosis of the urethra.
- Iatrogenic CausesMedical interventions such as catheterization, endoscopic procedures, or previous urethral surgery may inadvertently damage the urethra and result in stricture formation.
- Congenital CausesRarely, some individuals may be born with urethral narrowing that predisposes them to stricture formation later in life.
Symptoms and Clinical Presentation
Bulbar urethral strictures often present with gradual onset of urinary symptoms. The most common signs include
- Weak or intermittent urinary stream
- Spraying or deviation of urine
- Straining during urination
- Feeling of incomplete bladder emptying
- Urinary retention in severe cases
- Recurrent urinary tract infections
- Pain or discomfort in the perineum or lower abdomen
Early recognition of these symptoms is important, as untreated strictures can lead to chronic bladder dysfunction, kidney damage, or recurrent infections.
ICD-10 Coding for Bulbar Urethral Stricture
The International Classification of Diseases, Tenth Revision (ICD-10), provides a standardized system to classify and document medical conditions, including urethral strictures. Accurate ICD-10 coding is essential for medical records, insurance claims, and epidemiological research. Bulbar urethral stricture has specific codes that reflect its anatomical location and severity.
Relevant ICD-10 Codes
- N35.1Stricture of urethra – This code is generally used for strictures in the male urethra and includes bulbar, penile, or membranous segments when the specific location is not detailed.
- N35.2Traumatic urethral stricture – Used when the stricture results from trauma, including injury to the bulbar urethra.
- N35.8Other urethral stricture – This code applies when the stricture is in a specific location such as the bulbar urethra but does not fit into the other categories.
- N35.9Urethral stricture, unspecified – Used when the exact location or cause of the stricture is not documented.
It is recommended to document the specific location, cause, and severity of the stricture to select the most accurate ICD-10 code. This helps in proper treatment planning, reporting, and insurance processing.
Diagnostic Evaluation
Diagnosing a bulbar urethral stricture involves a combination of patient history, physical examination, and imaging studies. Key diagnostic steps include
1. Medical History and Symptom Assessment
- Assessing urinary symptoms such as weak stream, straining, and frequency
- History of trauma, infections, catheterization, or prior urethral surgery
- Evaluating for recurrent urinary tract infections or retention episodes
2. Physical Examination
Physical examination may include palpation of the perineum and penis, as well as assessment of bladder distension. In some cases, examination under anesthesia may be required for further evaluation.
3. Imaging and Endoscopic Studies
- Retrograde urethrogram (RUG) – X-ray imaging of the urethra using contrast to detect narrowing and its length
- Voiding cystourethrogram (VCUG) – X-ray taken during urination to evaluate urethral flow
- Urethroscopy – Endoscopic visualization of the urethra to assess stricture location and severity
Treatment Options
The management of bulbar urethral stricture depends on the length, severity, and cause of the stricture. Treatment strategies include
1. Minimally Invasive Procedures
- Dilation – Gradually stretching the narrowed urethra using special instruments
- Direct visual internal urethrotomy (DVIU) – Endoscopic incision of the stricture to widen the urethral lumen
2. Surgical Repair
For longer or recurrent strictures, surgical reconstruction may be necessary. Options include
- Excision and primary anastomosis – Removal of the narrowed segment and reconnection of the healthy urethra
- Urethroplasty – Reconstruction using tissue grafts or flaps to restore urethral patency
3. Postoperative Care
Postoperative management involves catheterization, antibiotics to prevent infection, and regular follow-up to monitor for recurrence. Long-term monitoring may include repeat imaging and symptom assessment.
Prognosis and Quality of Life
With proper diagnosis and treatment, patients with bulbar urethral strictures can achieve significant improvement in urinary function. Early intervention helps prevent complications such as recurrent infections, bladder dysfunction, and kidney damage. Lifestyle modifications, adherence to follow-up, and monitoring for recurrence are essential to maintain long-term urinary health and quality of life.
Bulbar urethral stricture is a narrowing of the urethra in the bulbar segment, leading to urinary difficulties and potential complications. Causes range from trauma and infections to iatrogenic factors and congenital abnormalities. Accurate ICD-10 coding, such as N35.1, N35.2, N35.8, or N35.9, is vital for proper documentation, treatment planning, and insurance purposes. Diagnosis relies on patient history, physical examination, and imaging studies including retrograde urethrograms and urethroscopy. Treatment options vary from minimally invasive dilation and internal urethrotomy to surgical urethroplasty for more complex cases. Early detection, effective treatment, and ongoing follow-up ensure optimal outcomes, improved urinary function, and enhanced quality of life for patients affected by bulbar urethral strictures.