Urethral Stricture Disease
The urethra is an important part of the urinary tract. It helps to pass urine out of the body and also helps men ejaculate. At times, certain conditions result in development of urethral disorders, such as urethral stricture disease.
What does a urethra do?
The urethra is a long tube which stretches from the bladder opening to the penile hole. The urine is transported by the urethra in its various stages, including prostatic urethra followed by membranous urethra (including external urinary sphincter). These together form posterior urethra, which is around a couple of inches in length. The next stage is the bulbar urethra and eventually the penile urethra, ending at the meatus (penis’ hole).These stages make the anterior urethra, measuring around 10 inches in length.
What is a urethral stricture?
A urethral stricture is a scar in or around the urethra, which can block the flow of urine, and is a caused by inflammation, injury or infection.
Who is at risk for urethral strictures?
Urethral strictures are more common in men because their urethras are longer than those in women. Male urethras are more susceptible to disease or injury. This is rarely seen as a congenital disorder.
What are some causes of urethral stricture?
Urethral strictures can occur anywhere along the length of the urethra. Infection and injury are the most common causes for this. However, in many cases it is difficult to pinpoint the exact cause.
Often, urethral structures occur as a result of surgeries, including prostate surgery, kidney stone removal, urinary catheterization, etc.
What are the symptoms of urethral strictures?
Symptoms that are seen in urethral strictures include:
Slow urine stream
Decreased urine output
Spraying of the urine stream
Blood in the urine
How are urethral strictures diagnosed?
Urethral strictures can be a result of a small blockage or narrowing in the urethra which affect the efficient flow of urine. When a patient begins to notice the symptoms of urethral strictures, it is advisable to seek medical attention immediately and avoid damage to the kidneys.
Diagnosis of suspected urethral strictures includes an initial physical examination. Apart from this, imaging tests, such as x-ray, ultrasound and Urethroscopy are useful for diagnosis too.
Retrograde urethrogram is a useful test to detect and evaluate the stricture in the urethra in more detail, which helps with better treatment.
How can urethral strictures be prevented?
Avoiding injury or trauma to the urethra and pelvis is the best way to prevent urethral stricture. Take excessive care when performing self-catheterization as well and avoid doing it frequently.
Strictures in urethra are also seen as a result of several STDs (sexually transmitted diseases) which cause inflammation in the urethra.
What are some treatment options for urethral structure disease?
There are several different treatment options for urethral stricture disease. The exact treatment will mainly depend on the location, degree and type of scar tissue causing the stricture.
These are the common treatment methods for urethral stricture disease:
This is a simple treatment and is performed as an outpatient procedure by a urologist. The urologist may choose to insert progressively larger dilators (sounds) into the urethra and helping to eventually expand the narrowed stricture.
Apart from this, the urologist may also choose to use a catheter with a surgical balloon fitted at the end to gently expand the stricture. This is most often advised to be done as a self-treatment by the patient as this needs to be repeated for most effectiveness.
In this, a special cystoscope with a knife blade or laser attached to the end is gently inserted into the urethra. The blade or laser effectively helps to cut and remove the stricture scar tissue and help expand the narrowed urethral passage.
In this treatment, a cystoscope is used to insert a metallic stent into the urethra. The stent is then expanded within the stricture and widens the narrowed urethral tube. The stent is placed in the stricture and is eventually absorbed by the urethral tissue.
This minimally invasive treatment is useful for treating sever strictures of the urethra.
Open surgical urethral reconstruction
There are several surgical reconstructive procedures for treating urethral strictures. The exact type of procedure for treatment mainly depends on the type of stricture as each of these procedures help treat a particular type of stricture.
Open surgical urethral reconstruction involves surgically removing the stricture and reconnecting the two separated ends using anastomotic urethroplasty procedure.
A substitution procedure is required in case the stricture tissue is considerably longer. In this, tissue is transferred to enlarge the narrowed urethral segment.
This surgical treatment is best-suited for smaller (2 cm and less) strictures. This allows the separated urethra tube to be reconnected after removing the stricture. This is an outpatient procedure and is comparatively easier to perform.
Free Graft Procedures: This procedure is fit to treat strictures that are longer than 2 cm with tissue grafts. This helps to enlarge the narrowed urethra again. Soft skin tissue is used from the patient’s body as graft material.
Skin Flap Procedures: In case the stricture is considerably long and cannot be treated with a free graft procedure the surgeon may use flaps of skin from the penis to ensure that the new urethra survives.
Staged Procedure: In case there is no sufficient skin flap for treating the stricture and there is lack of sufficient local skin tissue for free graft this procedure is performed. The surgeon will make an incision underneath the penis to expose the length of the urethra and locate the stricture. A graft is fixed under the opened urethra and a hole at the base of the penis is used until the graft material takes complete hold. Once the graft tissue heals, the surgeon will reshape it into a tube and this allows normal urination again.