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Urethral-Stricture
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 Urethral Stricture

The urethra serves as the conduit for expelling urine from the body. When this passage narrows, it can lead to discomfort and difficulty during urination, a condition known as urethral stricture. In certain instances, prompt medical intervention may be necessary to address a urethral stricture.

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What is a urethral stricture?

A urethral stricture is when the urethra becomes narrowed. The urethra is the tube responsible for carrying urine from the bladder through the penis and out through the urethral meatus (the opening at the tip of the penis) during urination.

Men with a stricture may experience worsening discomfort during urination and a decrease in the speed of the urinary stream. This can occur gradually, leading to the need for pushing or straining to urinate. Alternatively, the issue may suddenly arise without previous difficulty, necessitating immediate attention.

Symptoms and Causes

What causes urethral stricture?
Urethral stricture is primarily caused by chronic inflammation or injury. This can result in the gradual formation of scar tissue due to:

1. Injury to the penis or scrotum, including straddle injuries to the scrotum or perineum.
2. Infections, often transmitted sexually such as chlamydia.
3. Insertion of catheters or medical instruments into the urethra during surgical procedures.

The presence of scar tissue narrows the urethra, impeding the flow of urine. Sometimes, the inflammation or injury occurs long before the stricture becomes evident, while in other instances, the stricture develops shortly after a urethral injury.

What are the symptoms of urethral stricture?
Urethral stricture typically manifests through symptoms related to urinary dysfunction. These may include:

1. Difficulty or straining while urinating.
2. Pain experienced during urination.
3. Occurrence of urinary tract infections.
4. Inflammation of the prostate gland, termed prostatitis.

In severe cases, individuals with urethral strictures may encounter complete urinary blockage, known as urinary retention, posing a medical emergency. Additionally, complications such as hydronephrosis (kidney swelling) and renal failure can arise due to the backflow of urine into the kidneys from a poorly draining bladder.

Moreover, the proximity of the urethra to the prostate can lead to prostatitis, further exacerbating symptoms. Complicated urinary tract infections may also result from urinary backup, requiring antibiotic therapy and treatment addressing the underlying urethral stricture.

Diagnosis and Tests

How is a urethral stricture diagnosed?

Non-invasive tests can detect difficulties with bladder emptying but cannot conclusively pinpoint a stricture. Urine flow rate can be assessed by voiding into a collection device; a slow flow may indicate urethral blockage or a weak bladder. Post-void residual volume, measured via ultrasound, can reveal retained urine, which suggests a stricture. However, non-invasive tests cannot pinpoint whether these issues stem from a stricture, enlarged prostate, weak bladder, or other factors.

When a urethral stricture is suspected, imaging procedures are necessary for accurate identification and measurement. One such procedure is a retrograde urethrogram, an X-ray technique utilizing a contrast agent injected into the penile opening to highlight the stricture's location and length. Sometimes, patients are asked to urinate during the procedure to visualize the stricture during voiding.

Cystoscopy involves inserting a small, flexible camera (cystoscope) into the penis to visualize the urethra. Typically performed in a Urologist's office, this five to ten-minute procedure involves prior application of lidocaine jelly to ease discomfort during cystoscope insertion into the bladder.

Management and Treatment

How is urethral stricture typically treated?

The course of treatment hinges on diagnostic findings from imaging procedures and may encompass several options:

  1. Urethral dilation.

  2. Internal urethrotomy.

  3. Urethral reconstruction.

For short strictures, initial attempts may involve urethral dilation or internal urethrotomy. Conducted under general anesthesia, urethral dilation entails gradually widening the urethra using a sequence of progressively larger dilating instruments alongside a cystoscope. Meanwhile, internal urethrotomy involves utilizing a cystoscope with a specialized tool to incise the ring of scar tissue, thereby opening the obstructed area.

Following either procedure, a urethral catheter typically remains in place for three to five days. Although recurrence of the stricture is a common issue post-dilation or urethrotomy, successful resolution is attainable in certain cases. It's normal to experience blood in the urine temporarily following such interventions or any urinary tract procedure.

Should dilation or urethrotomy prove ineffective and the stricture recurs, the next step may involve urethral reconstruction to achieve a lasting solution. This may entail removing scar tissue and suturing the urethral ends together, known as urethroplasty. Alternatively, if direct reconstruction isn't feasible, the urethra may be reconstructed using tissue from the inside of the cheek or skin flaps from the genital area. Despite the variation in technique, these methods generally offer favorable long-term success rates for urethral reconstruction in most cases.

Prevention

How can I avoid urethral stricture?
Preventing injury to the pelvic region of the body might reduce the risk of certain types of urethral strictures. Additionally, practicing caution to prevent infections could also be beneficial in averting this condition.

A Message from NU Urology and Andrology Clinics

Urethral stricture typically carries a favorable prognosis and is manageable. Despite its treatability, recurrences are possible, often necessitating multiple procedures. It's important to schedule follow-up appointments with our Urologist post-treatment for urethral stricture.

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