Urethral stricture: needs early diagnosis and treatment.

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Urethral stricture: needs early diagnosis and treatment.

Urethral stricture: needs early diagnosis and treatment.

Urethral stricture: needs early diagnosis and treatment.

 

Urethral stricture is a very frequently common urological problem. In this disease, there is a narrowing of the tube, that carries urine from the urinary bladder out of the body. The most common cause of this narrowing is an injury to the lining of the urethra. Healing at the injury takes place by the formation of scar tissue that causes narrowing of the urethral lumen.

The narrowing can happen at any part of the urethra and causes difficulty in passing urine.

Causes of urethral stricture

1.         Accidents: Fracture of hip bone can cause damage to the urethra.

2.         Infection: Gonorrhea is a sexually transmitted disease and is known to cause bad strictures.

3.         Any intervention via urinary passage: Urinary catheter put in for any reason or surgery of prostate or bladder stones can lead to stricture.

4.         Other causes: Rarely stricture can be since birth.

 

 Signs and symptoms of urethral strictures

 

 

1.         Difficulty in passing urine

2.         Incomplete emptying of the bladder

3.         Frequent urination

4.         Recurrent urinary tract infection

 

Diagnosis

 

It is relatively easy to diagnose urethral stricture by talking to the patient. Further tests are done to find the exact site of stricture and to check for any complication which might happen due to urethral stricture. Tests like Ultrasound of kidneys, ureter, and bladder are routinely done. Ascending urethrography provides information about the site and severity of stricture.

Complications of urethral stricture disease

•           Urine retention: the inability to pass urine

•           Urinary incontinence:  loss of control over passing urine

•           Hydronephrosis / Kidney failure: there is swelling on the kidney with reduced function. Bladder muscle damage: the bladder muscle can become permanently weakened

•           Reflux: urine flowing back up into the kidney

How are urethral strictures treated?

The commonly used treatments are urethral dilatation, visual internal urethrotomy (VIU), and open surgical urethroplasty.

Dilatation

A metal dilator is used to dilate the narrowed part of the urethra this process usually involves repeated treatments with progressively larger dilators. Although it is a simple procedure some times it may cause complications like infection, trauma with false passages, and bleeding. One of the biggest drawbacks of dilatation is the very high incidence of re-stricture formation.

Clean Self Intermittent Catheterisation (CSIC)

To avoid repeated hospital admission for dilatation selected patients may be put on a schedule of CSIC. Here the patient is taught self-dilatation and he can do this in the privacy of his home using a non-traumatic urethral catheter with all aseptic precautions.

Visual Internal urethrotomy

This is the commonest procedure done for this disease. Under regional anesthesia, the area of the stricture is cut open with a cold knife. The procedure is done under telescopic vision. After the procedure, a catheter is placed in the urinary passage for 24 – 48 hours.

VIU has an advantage over dilatation in that this procedure is done under vision hence the incidence of trauma to the urethra is very less. The recurrence rate after VIU is less than dilatation though it is still quite frequent. The recurrence depends on the density of the original stricture. VIU cures superficial strictures, but deeper strictures with fibrosis may have a significant recurrence rate. In view of the high recurrence rate patient may have to be put on regular dilations or CSIC to keep the passage open.

Open surgical repair (Urethroplasty)

Open surgeries are called urethroplasty done for stricture urethra. These are done for complicated strictures and post-traumatic strictures. They are also indicated when simple procedures like VIU do not give satisfactory treatment results or have to be repeated too often.

This invasive surgery requires the use of general or regional anesthesia.

Urethroplasty is a successful procedure in many difficult situations but it involves a major surgical procedure with a long hospital stay and a long period of catheterization. patients may have a recurrence after urethroplasty hence patients have to be under regular follow-up. Few patients may need CSIC after urethroplasty.

Though urethroplasty is successful in nearly 90% of patients it is due to its side effects that alternative but lesser successful procedures like VIU are being tried.

You need an expert urologist to treat these complex issues and may need a second opinion if any doubt.

Prevention is better than cure!

Stricture can definitely be prevented. Practicing safer sex behaviors may decrease the risk of contracting sexually transmitted diseases and subsequent urethral stricture.

Early treatment of urethral stricture may prevent complications such as kidney or bladder infection or injury.

Dr. Rakesh Rai. MS, FRCS, MD, CCST, ASTS Fellow.

www.myvirtualhospital.com