Index
Introduction:
A urethral stricture is a narrowing of a section of the urethra. This causes a blocked or reduced urine flow, leading to complications. Several treatment options try to expand the narrow area of the urethra.
The urethra is the tube that carries urine from the bladder. It goes through the penis in men. The urethra is much shorter in women and ends just above the vagina. (In men, semen is ejaculated through the urethra as well).
What is a urethral stricture?
It is a narrowing that occurs when a part of the urethra is reduced. Any section of the urethra can be affected. Some scar tissue around the affected urethra causes part of the narrowing. The stenosis length varies from less than 1 cm in the size of the urethra. Urethral stricture is uncommon in men and rare in women.
Causes of urethral stricture
Injuries or damage to the urethra can be cured with scar tissue that can cause a stricture. Several types of damage can damage the urethra. For example, an injury may occur during medical procedures to look inside the bladder through the urethra; radiation treatment may damage the urethra; A blow mounted on the frame of a bicycle can cause damage.
Infection of the urethra is another issue, for example:
Infections such as sexually transmitted chlamydia or chlamydia. Infection as a long-term complication can be treated with a catheter to drain the bladder. The disease can cause inflammation in the tissue surrounding the urethra. These infections usually have a specific treatment but may leave some scarring at the site of the inflammation, which can cause a stricture. Most conditions do not cause urethral stricture. Stenosis is only a possible complication of an infection of the urethra.
- Congenital – some babies are born with a urethral stricture.
- Cancer – very rarely urethral cancer can cause criticism.
Which are the risk factors?
Some men have a high risk of developing urethral stricture, especially those who have:
- Have had or have one or more sexually transmitted infections.
- I recently used a catheter (a small, flexible tube inserted into the body to drain urine from the bladder).
- He had urethritis (swelling and irritation in the urethra), possibly due to an infection.
- An enlarged prostate .
What are the symptoms of a urethral stricture?
There may be no symptoms initially. However, the following symptoms – which may get worse over time – may occur:
- Reduction of urine flow is the first common symptom. Tension when urinating is standard, but a complete blockage of urine flow is rare.
- The spraying of urine or a double-flow can occur.
- Dribbling of urine for a while after urinating.
- It happens more often (need to urinate more often than usual) urine infections.
- You can have a small force like that of an ejaculation.
- Sometimes mild pain when urinating.
- Sudden and frequent urination.
- A feeling of incomplete emptying of the bladder after urinating.
- Frequent onset and arrest of the urinary stream.
- Inability to control urination (incontinence).
- Pain in the pelvic or lower abdominal area.
- The urethral discharge.
- Swelling and pain in the penis.
- Presence of blood in semen or urine.
- Darkening of urine.
- Inability to urinate (this is very serious and requires immediate medical attention).
How is urethral stricture diagnosed?
Doctors can use several approaches to diagnose urethral stricture:
Review of your symptoms and medical history
Your doctor can ask about past illnesses and medical procedures to determine if one or more risk factors are present.
Physical exam
A simple physical examination of the area of the penis can help the doctor identify the presence of urinary stenosis. For example, the doctor will quickly see the redness (or urethral discharge) and discover if one or more areas are stiff or swollen.
Testing
To make a definitive diagnosis of urethral stricture, the doctor may also decide to perform one or more of the following tests:
- Measurement of the flow rate during urination.
- Analysis of the physical and chemical properties of urine to determine if bacteria (or blood) are present.
- In cystoscopy, insert a small tube with a camera in the body to see inside the bladder and the urethra (the most direct way to verify the stenosis).
- Measure the size of the urethral opening.
- Chlamydia and gonorrhea tests .
What are the possible complications?
The pressure of the bladder muscle is needed to urinate through stenosis (which acts as a bottleneck). Not all urine in the bladder can be passed when you go to the bathroom. Some may accumulate urine in the bladder. In this way, the pool of residual urine is more likely to be infected. What makes it more prone to bladder, prostate, and kidney. They can also develop an abscess (ball infection) above the stricture. This can cause further damage to the tissues of the urethra and bladder. Urethral cancer is a rare complication of long-term stenosis.
What are the required tests?
Tests to determine the urine flow rate are usually recommended if there is a suspicion of urethral stricture. This involves measuring the passage of urine per second. The flow rate is reduced considerably if you have stenosis.
A look in the urethra is required to evaluate the stenosis through a special thin telescope. By special X-rays, the measurement can be taken while urinating; it can show the location and severity of the stenosis.
What is the treatment for urethral stricture?
The treatment usually recommended to improve the rate of urine flow, relieve symptoms, and prevent complications includes the following: the only advice from your specialist will depend on factors such as the location and duration of the narrowing and the age and general well-being.
Dilation (expansion) of a stenosis
This is usually done using a thin plastic rod (dance) in the urethra. This procedure can be performed either with local or general anesthesia. They are inserted, increasing the thickness to gradually expand (dilate) the stenosis. The goal is to lengthen and widen the stenosis without causing additional scars.
However, a gradual narrowing often tends to decrease again after each expansion. Therefore, a recurrence of dilation is usually necessary from time to time or when the symptoms recur. (Some people use a self-lubricating catheter inserted regularly to maintain dilated stenosis).
As a general rule, the smaller the stenosis, the greater the probability of a cure with dilation. It is a relatively straightforward procedure to perform, so it can be an option in the first place.
Uretrotomy
A thin telescope is used in the urethra to see precisely where the narrowing is in this procedure. This is done under a general anesthetic. A small knife is then placed in the telescope, which cuts along the stenosis. This extends the narrowed stenosis. You will get some relief from the symptoms with this procedure. About one case in three is cured forever. However, as the expansion, the narrowing can be reshaped, and the process can be repeated over time in some cases.
The smaller the stenosis, the greater the chance of a cure with this procedure. For example, one study found that with a urethrotomy performed by less than 2 cm stenosis, there was a recurrence of symptoms in the next 12 months to around 4 out of 10 cases. However, there was a recurrence in 10 points in 8 to 12 months when the stenosis was more significant than 4 cm.
Surgery
Corrective surgery may be an option if the previous treatment does not work. Various techniques are used. For example, a short narrowing can be cut, and both ends of the urethra are joined.
If the stretch is more significant, a type of operation similar to a skin graft is performed on the inner lining of the urethra. A graft is usually used inside the cheek to form the new section of the urethra. The techniques continue to improve, and the specialist will indicate if it is likely to be successful with treatment and if an operation is the best option for the removal and localization of the stenosis. There is a high success rate of curing symptoms with these operations as a general rule.
Stent placement
People who are not suitable for surgery due to age or other illnesses can be offered a Stent. This is a spring-like device that keeps the walls of the urethra open and prevents the stenosis from blocking the flow of urine. It is used as a last resort since the device can sometimes detach and cause pain during intercourse.
Antibiotics
Prolonged antibiotics may be necessary to prevent urine infections until they spread to urethral stricture.
How are urethral strictures followed after repair?
There is a risk of recurrence of urethral stenosis, so follow-up is essential. The doctor will ask you questions about the strength of the urine flow, the frequency of urination, the feeling of complete or incomplete bladder emptying, the direction of urine flow, and other symptoms of urethral strictures.
During these follow-up visits, you may be asked to void a unique collection device to measure the rate of urination and the flow of urination.
After urinating, a small ultrasound probe can be placed in the lower abdomen to measure the amount of urine left in the bladder (post-vacuum residue). In some cases, cystoscopy can be performed to observe the area of the urethra that was repaired directly.
Urethral strictures in children can be a consequence of diaper irritation (meatal stenosis), trauma, surgery, previous instrumentation, or congenital. They will often appear with symptoms similar to those of adults.
Meatal stenosis is a narrowing of the opening in the tip of the penis and is thought to occur by irritation of the diaper in circumcised children.
It can also occur after the repair of hypospadias. Symptoms include decreased or deviated urine flow. Carrying out a meatotomy / metaplastic, crushing the scar tissue bridge, and cutting it afterward, is successful in 98% to 100% of children.
Dilatation is not recommended for urethral strictures in the penile urethra to the bulbar urethra. It removes the stenosis if feasible and primary reinsertion of the urethral ends is more effective. A buccal mucosa patch graft is successful when this cannot be achieved.
What is the recovery period after surgery?
The recovery period after surgery will vary with the procedure performed, the catheterization duration, the surgeon’s preference, and the general state of health. After almost all surgeries, a catheter is left in the penis to treat urethral stricture.
The length of time the catheter remains in place will depend on the procedure performed and the surgeon’s preference. Typically, the catheter is left in place for at least a week.
In some cases, a suprapubic tube (a tube that traverses the lower abdomen to the bladder) may be left to drain urine in addition to the catheter.
With less invasive procedures, the duration may be shorter. The discomfort associated with the system will also vary with much less pain with more minor invasive procedures, urethral dilation, and internal urethrotomy.
With more extensive surgery (urethroplasty), a more prolonged course can be expected, which varies with the extent of the surgery. Procedures such as dilation and internal urethrotomy are outpatient procedures, while more complex repairs may be associated with a hospital stay at night.
How can I prevent urethral stricture?
It is not always possible to prevent urethral stricture. Since sexually transmitted infections are a cause, protection during sexual contact can prevent some cases. However, injuries and other medical conditions associated with urethral stricture can not always be avoided.
It is essential to consult a doctor immediately if you have symptoms of urethral stricture. Treating the problem quickly is the best way to avoid serious complications.
What is the long-term perspective?
Many people have good results after the treatment of urethral stricture. You may also need future treatments if the criticism results from a scar.
