STRICTURE URETHRA

 
Urethral stricture refers to any narrowing of the urethra for any reason whether or not it actually impacts the flow of urine out of the bladder. Any inflammation of urethra can result in scarring, which then can lead to a stricture or a narrowing of the urethra. Trauma, infection, tumors, surgeries, or any other cause of scarring may lead to urethral narrowing or stricture. Mechanical narrowing of the urethra without scar formation (developmental causes or prostate enlargement) can also cause urethral stricture. Urethral stricture is significantly more common in men and boys compared to women and girls. This condition is considered rare in females.

Injury or damage to the urethra can heal with scar tissue that may cause a stricture. There are various types of injury that can damage the urethra. For example, an injury may occur during medical procedures to look into your bladder via your urethra; radiotherapy treatment may damage your urethra; a fall astride on to the frame of a bike can cause damage.Infection of your urethra is another cause - for examples Sexually transmitted infections such as gonorrhoea or chlamydia. Infection as a complication of the long-term use of a tube (catheter to drain your bladder.Infection may cause inflammation in the tissues in and around your urethra.

Symptoms of Urethral Stricture :


-Difficulty starting urine flow
-Painful urination (dysuria)
-Urinary Tract Infection (UTI)
-Urinary Retention
-Incomplete emptying of bladder
-Decreased urine stream
-Dribbling of urine
-Spraying or double streaming urine
-Blood in the urine (hematuria)
-Blood in the semen
-Urinary incontinence
-Pelvic pain
-Discharge from the urethra

Diagnosis of Urethral Stricture


Cystoscopy:

It is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The cystoscope is inserted into your urethra and slowly advanced into the bladder.

Urethrography:

A retrograde urethrogram is a routine radiologic procedure used to image the integrity of the urethra. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture.

Surgery of Urethral Stricture

Laser endoscopic urethroplasty (OIU): here first endoscoipc examination of urethra is done to see extent and severity of stricture. in short stricture at one point 12 o clock stricture is sharply cut with laser energy to widen the urethral lumen. A Foley catheter is left for 5 days for healing. technique is good for short less dense stricture. many a time patient is adviced for self calibration of urethra to prevent recurrence.


End to end urethroplasty: here urethra is exposed from perinium (below scrotum). the strictured segment of urethra is excised. and continuituy is mantained by anastomosing normal end of urethra over a catheter. catheter is usually kept for 14 days. technique is good for short severly dense stricture. success rate is very good.ˇ