Urethral stricture refers to the narrowing of the urethra, the tube that carries urine from the bladder out of the body. This narrowing can impede the flow of urine, leading to various urinary symptoms. Here are comprehensive details about urethral stricture:
Causes of Ureteric Stricture:
- Trauma: Injuries to the urethra, such as pelvic fractures or catheterization, can lead to scar tissue formation and stricture.
- Infection: Sexually transmitted infections (STIs), urethritis, or urinary tract infections (UTIs) can cause inflammation and scarring of the urethra.
- Inflammatory Conditions: Conditions such as lichen sclerosus, balanitis xerotica obliterans (BXO), or chronic urethritis can lead to urethral narrowing.
- Medical Procedures: Previous surgeries involving the urethra or nearby structures can sometimes result in scar tissue formation and stricture.
- Radiation Therapy: Treatment for pelvic cancers can lead to urethral scarring and narrowing.
- Congenital Defects: Rarely, individuals may be born with abnormalities in the structure of the urethra that predispose them to strictures.
Symptoms of Ureteric Stricture:
Urinary Symptoms:
- Difficulty starting urination (hesitancy)
- Weak urine stream
- Urinary urgency
- Urinary frequency
- Incomplete emptying of the bladder
- Dribbling at the end of urination
Complications:
- Urinary retention: Inability to empty the bladder completely
- Urinary tract infections (UTIs)
- Bladder stones
- Kidney damage (rare but possible in severe cases)
Diagnosis of Ureteric Stricture:
- Medical History and Physical Examination: A healthcare provider will inquire about symptoms and perform a physical examination, which may include a digital rectal exam (DRE) in men.
- Urethral Imaging: Tests such as urethrography or retrograde urethrography may be performed to visualize the urethra and identify areas of narrowing.
- Urodynamic Studies: These tests evaluate bladder and urethral function and may help in diagnosing urethral strictures.
Treatment Options for Ureteric Stricture:
Surgery for urethral stricture aims to widen or reconstruct the narrowed portion of the urethra to restore normal urine flow. The choice of surgical procedure depends on factors such as the location, length, and severity of the stricture, as well as the patient’s overall health and preferences. Here are the details of common surgical procedures for urethral stricture:
Urethral Dilation:
- Procedure: Urethral dilation involves stretching the narrowed portion of the urethra using progressively larger dilators.
- Technique: The surgeon inserts a series of dilators into the urethra to gradually widen the narrowed area.
- Benefits: Urethral dilation is a minimally invasive procedure that can be performed in the outpatient setting.
- Considerations: It may provide temporary relief but often requires repeated procedures as scar tissue can reform.
Urethrotomy:
- Procedure: Urethrotomy is a minimally invasive procedure where a small incision is made in the scar tissue to widen the urethra.
- Technique: The surgeon uses a scalpel or laser to make an incision in the scar tissue, allowing for improved urine flow.
- Benefits: Urethrotomy is less invasive than open surgery and can be performed on an outpatient basis.
- Considerations: It may be less effective for longer or more complex strictures, and recurrence is common.
Urethral Stenting:
- Procedure: Urethral stenting involves placing a stent (a tube) in the urethra to keep it open temporarily or permanently.
- Technique: The stent is inserted into the urethra, expanding it and providing support to prevent re-narrowing.
- Benefits: Urethral stenting can provide immediate relief and may be suitable for short or complex strictures.
- Considerations: Stents can sometimes migrate or cause irritation, and long-term complications such as encrustation or infection are possible.
Urethroplasty:
- Procedure: Urethroplasty is a surgical reconstruction of the urethra to remove the scar tissue and widen the urethral lumen.
- Technique: The surgeon may use tissue grafts from other parts of the body or perform tissue mobilization techniques to reconstruct the urethra.
- Benefits: Urethroplasty offers a more permanent solution with a lower risk of recurrence compared to dilation or urethrotomy.
- Considerations: It is a more extensive procedure requiring general or regional anesthesia and may have a longer recovery time.
Buccal Mucosal Graft Urethroplasty:
- Procedure: This technique involves using a graft of tissue from the inside of the cheek (buccal mucosa) to reconstruct the narrowed portion of the urethra.
- Technique: The buccal mucosal graft is harvested and then used to augment or replace the scarred urethral tissue.
- Benefits: Buccal mucosal graft urethroplasty is effective for longer or more complex strictures and has good long-term success rates.
- Considerations: It requires specialized training and may be associated with complications such as donor site morbidity or graft contracture.
Open Urethroplasty:
- Procedure: Open urethroplasty involves surgically removing the scar tissue and reconstructing the urethra using various techniques.
- Technique: The surgeon accesses the urethra through an incision in the perineum (the area between the scrotum and anus) or abdomen and performs the reconstruction.
- Benefits: Open urethroplasty is effective for longer or more complex strictures and offers a durable solution with a lower risk of recurrence.
- Considerations: It is a major surgery requiring general or regional anesthesia and may have a longer recovery time compared to less invasive procedures.
Complications of Ureteric Stricture:
Left untreated or poorly managed, urethral strictures can lead to complications such as urinary retention, urinary tract infections, bladder stones, and kidney damage.
Prognosis for Ureteric Stricture:
- The prognosis for urethral stricture depends on factors such as the cause, location, and severity of the stricture, as well as the effectiveness of treatment.
- With appropriate management, many individuals experience relief from symptoms and preservation of urinary function.
Conclusion:
Urethral stricture is a condition characterized by the narrowing of the urethra, which can lead to urinary symptoms and complications. Early diagnosis and appropriate treatment are essential to alleviate symptoms and prevent complications. If you suspect you have a urethral stricture or are experiencing urinary symptoms suggestive of obstruction, it’s important to consult a healthcare provider for proper evaluation and management.
