STRICTURE URETHRA

Urethral stricture disease is a condition characterized by the narrowing or obstruction of the urethra, the tube that carries urine from the Urinary bladder out of the body. This narrowing can lead to various urinary symptoms and complications, impacting a person’s quality of life. Understanding the causes, symptoms, diagnosis, and treatment options for urethral stricture disease is crucial for effective management and relief of symptoms.

Understanding Urethral Stricture Disease:

Urethral stricture disease refers to the narrowing of the urethra due to scar tissue formation or inflammation. This narrowing can occur anywhere along the length of the urethra, from the opening at the tip of the penis to the bladder. Urethral strictures can vary in severity, from mild narrowing that causes minimal symptoms to complete obstruction that prevents the passage of urine.

Causes And Risk Factors:

Urethral strictures can be caused by various factors, including:

• Trauma: Trauma to the urethra, such as from a pelvic fracture, catheterization, or surgery, can lead to scarring and narrowing of the urethral lumen.

• Infection: Infections of the urethra or surrounding tissues, such as sexually transmitted infections (STIs) or urinary tract infections (UTIs), can cause inflammation and scarring, leading to strictures.

• Inflammation: Chronic inflammation of the urethra, often due to conditions such as urethritis or balanitis, can contribute to the development of strictures.

• Congenital: Rarely, urethral strictures may be present at birth (congenital) due to abnormal development of the urethra.

• Medical Procedures: Certain medical procedures, such as repeated urethral catheterizations or prostate surgery, can increase the risk of developing urethral strictures.

• Age and Gender: Urethral strictures are more common in men, particularly older men, although women and children can also develop strictures.

Common Symptoms:

Urethral stricture disease can cause a variety of urinary symptoms, including:

• Decreased Urinary Stream: Reduced force of urine flow or difficulty initiating urination.

• Urinary Retention: Difficulty emptying the bladder completely, leading to frequent urination or a sensation of incomplete voiding.

• Urgency: Sudden and intense urge to urinate, often with difficulty delaying urination.

• Dribbling: Leakage of urine after urination is complete.

• Spraying: Uncontrolled or erratic urine flow due to obstruction or narrowing of the urethra.

• Straining: Straining or pushing to urinate, with a feeling of urinary hesitancy or incomplete bladder emptying.

• Urinary Tract Infections (UTIs): Recurrent UTIs may occur due to incomplete bladder emptying and urinary stasis caused by urethral strictures.

Diagnosis And Evaluation:

1. Medical History and Physical Examination: A healthcare provider, such as a urologist will begin by obtaining a detailed medical history and performing a physical examination. Key aspects of the medical history may include asking about urinary symptoms, past medical conditions, history of trauma or medical procedures, and sexual history. During the physical examination, the healthcare provider may palpate the abdomen and assess the genitalia for signs of inflammation or scarring.

2. Diagnostic Tests: Several diagnostic tests may be performed to confirm the diagnosis of urethral stricture disease and assess its severity, including:

• Uroflowmetry: A test to measure the rate and pattern of urine flow during urination, helping to assess urinary function and identify any obstruction.

• Cystoscopy: A procedure that involves inserting a thin, flexible tube with a camera (cystoscope) into the urethra to visualize the inside of the urethra and bladder, allowing for direct visualization of any strictures or obstructions.

• Urethrography: Imaging studies such as retrograde urethrography (RGU) and voiding cystourethrography (VCUG or MCUG) may be used to obtain detailed images of the urethra and identify the location and extent of strictures.

• Urodynamic Studies: These tests evaluate the function of the bladder and urethra, helping to assess urinary flow rates, bladder capacity, and bladder pressure.

Treatment And Management:

1. Urethral Dilation: Urethral dilation is a common treatment for urethral strictures and involves stretching the narrowed segment of the urethra using progressively larger dilators. This procedure can be performed in the office or operating room under local or general anesthesia.

2. Urethrotomy: Urethrotomy  is a minimally invasive procedure that involves making a small incision or incisions in the narrowed segment of the urethra to widen the lumen and improve urinary flow. This procedure may be performed using a cystoscope and special instruments.(also see Point no. 4)

3. Urethroplasty: Urethroplasty is a surgical procedure used to reconstruct or repair the urethra, particularly in cases of long or complex strictures that cannot be adequately treated with dilation or urethrotomy. Urethroplasty may involve removing the narrowed segment of the urethra and reconnecting the healthy ends (anastomotic urethroplasty) or using tissue grafts to repair the defect (substitution urethroplasty).

4. Optical Internal Urethrotomy: Internal urethrotomy (OIU) is a minimally invasive procedure that involves using a laser or cutting instrument to incise the narrowed segment of the urethra from the inside, allowing for the removal of scar tissue and widening of the urethral lumen.

5. Self-Catheterization: In cases of recurrent or persistent urethral strictures, self–intermittent catheterization may be recommended to help maintain urethral patency and prevent urinary retention. This involves inserting a catheter into the urethra at least once a day to dilate the stricture segment .

6. Follow-Up Care: Regular follow-up appointments with a healthcare provider are essential for monitoring symptoms, assessing treatment efficacy, and adjusting treatment as needed. In cases of recurrent strictures or complications, additional interventions may be necessary to maintain urinary function and quality of life.