Urethral stricture causes, symptoms and treatment

The kidneys play a crucial function in filtering waste from the body and excreting it in the urine. The urethra starts at the lower end of the bladder and continues to the exterior. Urethral stricture is an illness identified by any pathological constricting of the internal lumen of the urethra. Congenital strictures are thought about unusual.

Any swelling of the urethra as an outcome of injury, previous surgical treatment, or infection can trigger urethral stricture. Urethral stricture is a lot more typical in males than females, it is connected with a long urethra. To reward stenosis, urologists dilate the urethra by numbing it, then place an instrument that expands the lumen. There are other methods also.

  • Prevention
  • Classification

    Urethral strictures are categorized:

    By the degree of constricting of the lumen:

    • Subtotal – impacts as much as 2/3 of the urethra.
    • Total – nearly total constricting.
    • Obliteration – total constricting with clog of urine circulation.
    • Long (over 2 cm)
    • Medium (as much as 2 cm)
    • Short (no greater than 1 cm).

    In the course of the illness:

    • Recurrent – establishes once again after bougienage, stenting or urethroplasty.
    • Primary type – the client’s illness was found for the very first time.
    • Difficult – accompanied by problems: fistulas or abscesses.

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    By the nature of the illness:

    Congenital – genetically figured out irregularities throughout intrauterine advancement.

    Purchased products are divided into:

    • Inflammatory (urethral stricture brought on by tuberculosis, sexually transferred infections, gonorrhea and chlamydia.
    • Traumatic – emerging from blows, injuries or medical controls.
    • Iatrogenic – appears in their adult years due to stenosis of the urethra and recklessness in carrying out such treatments as: cystoscopy, catheterization, urethroscopy, bougienage, stone elimination, falloprosthetics, brachytherapy.

    By area:

  • Membranous – surrounded by a diaphragm.
  • Penile – encompasses the external opening.
  • Prostatic department – the prostate gland lies around.
    • Multiple strictures are formed in numerous locations of the urethra.
    • Single stricture – narrowing takes place in just one location.

    Causes

    Urethral stricture describes the constricting of the urethra for any factor. The reason for urethral stenosis can be:

    • Urinary system infection (eg, gonorrhea).
    • Foreskin (glans) infection.
    • Inadequate surgical intervention.
    • Catheterization (particularly with long-lasting operations).
    • Tumors of the urethra.
    • Serious injuries in the swimming pool, at work or when falling from a height.
    • Technical controls such as catheterization, endoscopy, some sexual practices with foreign bodies: the resulting injury can cause scarring and for that reason narrowing of the urethra.
    • After extreme prostate surgical treatment or other urinary system surgical treatment.
    • Diseases diabetes mellitus or systemic atherosclerosis.
    • Genital tuberculosis.

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    Symptoms

    The symptoms of urethral stenosis can vary from moderate symptoms to finish urinary incontinence. In the preliminary phases of urethral stricture, symptoms might not be observed:

    • The urinary circulation is thinner, periodic, coiled and irregular.
    • Difficulty urinating, as much as and consisting of continence (emergency situation healthcare).
    • Instead of a stream, urine leaks.
    • Blood in urine or semen.
    • The existence of recurring urine after blockage of the circulation of urine.
    • Pain in the pelvic area.
    • Cystitis.
    • Burning experience when urinating.
    • Weak urine circulation.
    • It is needed to tighten up the stomach muscles while urinating.
    • Leakage of urine.

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    Diagnostics

    The primary kinds of diagnostics:

  • History based upon the client’s symptoms.
  • A study about previous transmittable illness and injuries of the urinary system.
  • Analysis of urine.
  • Ultrasound – finds the existence of recurring urine and figures out the condition of the bladder.
  • Urethrography – X-ray with contrast liquid.
  • Endoscopy of the urethra (urethroscopy).

    Treatment

    As a guideline, you require to see a professional (urologist) for treatment. The infection needs to be dealt with properly and prescription antibiotics are recommended. Surgical treatments are the primary treatment for symptomatic urethral stricture. The total diagnosis for urethral stricture is great. Patients need to be kept under control of their stricture illness with persistent urethral dilatation. The objective is to extend the scar without developing extra scarring. Urethral dilatation can be useful for clients with separated epithelial banners (without the participation of the corpus spongiosum).

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    Bougie

    Internal urethrotomy (dilation, bougienage of the urethra): This includes transurethral constricting (surgical treatment through the urethra) utilizing endoscopic devices.

    The cut permits scar tissue to be launched. Success depends upon finishing the epithelialization (injury recovery) procedure prior to contraction of the injury will substantially lower the calibration of the urethral lumen.

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    The cut is made under direct vision with a “cold” knife, or a surgical instrument to open the urinary canal, or a “hot” knife that utilizes an electrocautery (separating unhealthy tissue with a needle or unique loop) heated up with an electrical present to cut through the scar tissue. Care need to be taken not to harm the corpus cavernosum as this can cause impotence.

    Complications consist of: reoccurrence of stricture, which is the most typical problem, bleeding or watering into subcutaneous tissue, consequently increasing the fibrotic action.

    The success rate is 20-35%. Typically, an indwelling urethral catheter is left in location for 3 to 5 days to withstand the efforts of injury contraction and accelerate injury recovery. Catheterization after internal urethrotomy is utilized to increase the rate of treatment by keeping the urethral lumen open. The stricture might return.

    Stenting

    Placed endoscopically urethral stents: developed to be placed into the wall of the urethra. Complications take place when the stent is placed even more from the body of the urethra, triggering discomfort while sitting. This treatment is contraindicated in clients with thick strictures and previous restoration of urethral replacement, as it causes a hypertrophic response.

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    Optical urethrotomy

    Urethral cut: carried out under basic or regional anesthesia. An optical instrument is placed into the urethra, then the stenosis is broadened with a scalpel or laser probe. Then a catheter is put for numerous days. In most cases, for singular and basic urethral stenosis, this treatment suffices and no additional intervention is needed.

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    Surgical restoration

    Open surgery: The stenotic part is resected with a cut in the penis and covered with brand-new tissue (generally drawn from the foreskin or oral mucosa). After the treatment, the bladder catheter is put up until it recovers, for about 2 weeks.

    In basic, surgeries are straightforward and are not connected with urinary incontinence or impotence. In unusual cases, the operation needs to be duplicated. With extended sophisticated stenosis of the urethra, weakening of the muscles of the bladder might take place. In this case, there is a distension of the bladder, the development of diverticula and urolithiasis. Complications consist of urinary system infections, swelling of the epididymis (epididymitis), hydronephrosis, and persistent kidney failure with decreased kidney size. After treatment, urethral stricture might come back, so preventive steps need to be required to leave out reoccurrence.

    Laser treatment

    Laser treatment of constricting of the urethra is a technique utilizing contemporary devices. Endoscopic urethrotomy with elimination of scar tissue. At the start of the operation, the client needs to go through an optical modification of the urethra.

    Prevention

    Urethral stricture can be treated with folk solutions. A range of herbs are utilized for these functions. An outstanding anti-inflammatory representative is: black currant, juniper, lingonberry, black elderberry, chamomile, black poplar.

    Urethral stricture avoidance steps:

  • Competent catheterization method by medical workers.
  • Timely treatment of transmittable illness.
  • Personal health.
  • Adequate surgical treatment for injury to the walls of the urethra.
  • Timely surgical treatment.
  • Condom usage.
  • Avoid presenting any foreign items into the urethra.
  • Strengthening of resistance.

    Urethral stricture needs prompt medical diagnosis and treatment, overlook results in urination condition and severe problems.

  • Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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