Urethral stricture is a clinical situation when, under the influence of various external factors, a segmental reduction in the diameter of the urethra occurs, which primarily causes disorders in urination. What are the causes of urethral stricture? What symptoms may indicate them and how is the treatment going?

Forurethral strictureare responsible, among others, for a foreign body, cancerous changes, post-traumatic conditions or post-infection conditions. The clinical picture is limited to impaired micturition. These may be difficulties in urination, pollakiuria or pain during voiding. Undoubtedly, each of the symptoms listed should be alarming and is an indication for a medical consultation in order to confirm the diagnosis and implement adequate therapeutic treatment.

Causes of urethral stricture

The ailment's etiology is complex. The cause may be, on the one hand, congenital anatomical disorders, various types of developmental defects (hypospadias, chymatoma or the posterior urethral valve in male children), and on the other hand, there is a list of pathological conditions of the body that relatively increase the risk of a defect. These include, among others

  • cancer
  • foreign body / trauma around the perineum, e.g. a fracture in the pelvic bones
  • urolithiasis
  • urinary tract infections - especially bacterial; the most common pathogens include:Escherichia coli ,Staphylococcus saprophyticus ,Neisseria gonorrhoea
  • iatrogenic actions, i.e. all medical interventions. Urethral stricture can occur even after bladder catheterization or cystoscopy. Of course, the more advanced the medical procedure is, the risk of damaging the urethra and its subsequent narrowing is much higher.

It is worth mentioning that too long maintenance of the catheter, especially in long-term hospitalized patients, may not only cause urinary tract infections, but also cause narrowing of the urethra.

Symptoms of urethral stricture

Symptoms accompanying urethral stricture are complex. On the one hand, they result from the obstruction itself, but on the other hand, they are the result of irritation of the urinary tract. The most frequently reportedailments include:

  • disorders during urination (intermittent stream, reduced flow of urine, frequent urination, nocturia, i.e. the need to urinate at night)
  • feeling of incomplete emptying of the bladder
  • in advanced form even stopping the voiding completely

It happens that some patients do not feel any discomfort, in order to confirm the diagnosis, it is necessary to catheterize the patient, which fails.

Diagnosis of urethral stricture

The ailments that accompany the narrowing of the urethra are not very characteristic and may be associated with a completely different pathology. A well-collected interview with the patient is extremely important. A history of perineal trauma or urinary tract infection in a short period of time may direct the doctor's reasoning.

The leading diagnostic test is urethroscopy - it is an imaging test with the use of a special optical tool, inserted into the urethra, which allows for the visualization of the affected area.

Retrograde urethrography is another diagnostic tool. It consists in administering a contrast agent to the urethra, followed by an X-ray image. A variation of this test is the variant where the contrast agent goes to the bladder and the scan is taken during micturition.

Despite the availability of ever newer and more refined examinations, the more basic, but equally useful, even abdominal ultrasound examinations should be excluded. Thanks to this, it is possible to assess the residual urine immediately after voiding.

It is also worth performing basic laboratory tests that assess kidney function: urea, creatinine, urine test with culture.

Urethral stricture is differentiated with some bladder tumors, with bladder neck enlargement, and in men with prostate disease.

How To Treat Urethral Stricture

Treatment of the described disease is primarily surgical. To date, no effective pharmacotherapy has been developed. The surgical procedure consists in sliding the narrowed fragment of the urethra and then suturing the free fragments together with the filling of the defect using, for example, synthetic materials. The most popular methods include urethrotomy, which involves the insertion of a special cutting tool - the urethrotome, in order to incise the stricture site.

Unfortunately, the disease carries a high risk of complications. Most often it is a urinary tract infection, bladder calculi, periurethral abscess or fistulaurinary. Each complication requires appropriate therapeutic management and is associated with a medical consultation.

Category:

Urology and Nephrology