Urethral stricture

Urethral stricture could be defined as the narrowing of the urethra . This will  impact the flow of urine out of the bladder.

Inflammation of the urethra can lead to scarring, which then can in turn result in a stricture or narrowing of the urethra. Urethral stricture is more prevalent in men in comparison to women.
urethral-structure

Causes

  • Trauma caused by injury or accidents, consequently leading to damage to the urethra or bladder
  • Pelvic injury
  • Earlier procedures involving urinary catheters, surgeries and cystoscopy.
  • Earlier prostate surgery such as TURP or Transurethral Resection of the Prostate.
  • Urethral Cancer.
  • Infections of the urethra including sexually transmitted diseases such as urethritis, gonorrhea, and chlamydia.
  • Previous hypospadias surgery.
  • Congenital abnormalities of the urethra.

Symptoms

  • Experiencing difficulty in starting urine flow.
  • Pain while urinating.
  • Urinary tract infection (UTI).
  • Urinary retention.
  • Inability to fully empty the bladder.
  • Reduced urine stream.
  • Dribbling of urine.
  • Double streaming urine.
  • Blood in the urine.
  • Urinary incontinence.
  • Pelvic pain.
  • Discharge from the urethra.
  • Decreased ejaculation force.

Diagnosis

The diagnosis and tests conducted for evaluating urethral stricture include:

  • Evaluation of medical history.
  • Comprehensive physical examination.
  • Additional diagnostic tests such as Urinalysis (UA), urine culture, and urethral culture.
  • Imaging and endoscopic studies such as Ultrasound of the urethra, Retrograde urethrogram, Anterograde cystourethrogram and Cystourethroscopy.

Treatment

Surgery is the only option for  symptoms of urethral narrowing.

Different types of surgical procedures are performed for treating urethral strictures. Some of the common procedures include:

  • Urethral dilation
  • Optical Urethrotomy
  • Open urethral reconstruction ( Urethroplasty)

Urethral dilation

Urethral dilation is a common technique used for the treatment of urethral strictures. This procedure is generally done under local or general anesthesia. In this process, thin rods of varying diameters are gently inserted into the urethra through the tip of the penis so as to open up or widen the urethral narrowing without causing damage to the urethra. This procedure usually has to be repeated from time to time, as strictures have the chance of recurring.

 patients can be taught to do self dilatation

Endoscopic optical Urethrotomy

Urethrotomy refers to an endoscopic procedure that is generally performed under general anesthesia. An endoscope is inserted into the urethra to clearly view the stricture. Then, a small knife is passed through the endoscope in order to sever the stricture lengthwise to facilitate the smooth flow of urine. A urinary catheter is inserted and kept in position for some days while the incision is healing.

Open reconstruction (Urethroplasty)

Open reconstruction involves various techniques for the correction of urethral strictures. If the stricture segment is short , it can be excise and the normal looking both upper and lower ends of the urethra can be joined together . This is called Excision urethroplasty.

If the strictured segment is long, the stricture site is opend up and suitable graft material is usually taken from cheek mucosa or fom the lip and is sutured over the opened area to provide wider urethral lumen( Substitution urethroplasty)

 

 

 

Authored by Dr N Anandan