What is urethral stricture
The inside of the urethra is lined with mucous membrane, surrounded by spongy tissue. When this lining is damaged - by injury, infection or instrument - a scar forms at the site of the defect. Scar tissue is not elastic and gradually shrinks, narrowing the lumen of the canal.
At first, the bladder compensates for the narrowing with increased contraction, and the person does not notice the problem. Then the stream weakens, residual urine appears, and after it - infections, bladder stones and, in advanced cases, impaired kidney function.
The extreme degree of the process is obliteration, when the lumen of the urethra is completely blocked and independent urination becomes impossible.
Reasons
- Iatrogenic - the most common group: long-term catheterization, endoscopic operations, traumatic catheter installation
- Injuries: fracture of the pelvic bones with rupture of the urethra, fall with the perineum onto a hard object, injuries to the penis
- Inflammatory: previous urethritis, including gonorrheal, lichen sclerosus
- Consequences of prostate surgery
- Radiation therapy of the pelvic organs
- Congenital narrowings
- Idiopathic - when a clear cause cannot be established
Symptoms
- Thin, sluggish stream of urine, sometimes splashing or bifurcating
- The need to strain when urinating
- Prolongation of urination time
- Feeling of incomplete emptying of the bladder
- Increased urge, night rises
- Dribbling after urination
- Recurrent urinary tract infections and epididymitis
- Pain or discomfort when urinating
- Acute urinary retention as an outcome of progressive narrowing
Diagnostics
- Uroflowmetry - a characteristic flattened curve with a long plateau
- Ultrasound of the bladder with determination of residual urine
- Retrograde urethrography and voiding cystourethrography - a key study: shows the exact location, length and number of narrowings
- Ultrasound of the urethra - assessment of the length of the scar and the condition of the surrounding tissue
- Urethroscopy - direct examination of the canal
- General analysis and urine culture
- TRUS and PSA in older men to exclude concomitant prostate pathology
When choosing an operation, two parameters are critical: where the stricture is located and how long it is. They determine whether endoscopic dissection is sufficient or whether plastic surgery using their own tissue is required.
Treatment: endoscopic methods
- Bougienage of the urethra - mechanical expansion of the canal with bougies; gives a quick effect, but with a true scar stricture it is temporary
- Optical urethrotomy - dissection of the scar under visual control through a urethroscope; effective for short single strictures of the anterior urethra
- Installation of a urethral catheter for a certain period after dissection
Treatment: reconstructive surgery
- Anastomotic urethroplasty - excision of the scar area followed by suturing of the healthy ends of the urethra; used for short strictures
- Buccal urethroplasty - expansion of the narrowed area with a flap of mucous membrane taken from the inner surface of the cheek; method of choice for extended strictures
- Island and panurethral buccalplasty - for particularly long lesions
- Posterior anastomotic urethroplasty, including with pubectomy - for post-traumatic defects after pelvic fractures
- Johanson's two-stage operation - for complex, repeatedly operated strictures
- Formation of a perineal urethrostomy - an option if reconstruction is impossible
- Trocar cystostomy - temporary diversion of urine during retention or as a preparatory stage
The buccal mucosa is used because it is resistant to urine, takes root well, and its collection does not leave noticeable consequences. It is a material recognized throughout the world for urethroplasty.
Recovery and surveillance
- After the operation, a catheter is installed for a certain period of time; it is removed after a control study
- At first there may be swelling, discomfort and a small amount of blood.
- Limiting physical activity and sexual activity for a period prescribed by the surgeon
- Control uroflowmetry at certain intervals for several years
- If a weakening of the stream occurs, immediately contact a urologist without waiting for urinary retention
- Quitting smoking improves tissue healing
Prevention
- Timely and complete treatment of urethritis and sexually transmitted infections
- Minimizing prolonged catheterization; using catheters of the appropriate size
- See a doctor for any injury to the perineum or penis, even if the complaints seem minor
- Regular monitoring after endoscopic operations on the urethra and prostate
- Refusal of independent attempts at bougienage
Where is urethral stricture treated in Tashkent
Urethroplasty refers to reconstructive urology and requires special training of the surgeon, as well as preoperative diagnostics - urethrography and ultrasound of the urethra.
In Tashkent, treatment of urethral stricture, from optical urethrotomy to buccal and anastomotic urethroplasty, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
It is useful to take all previous extracts and photographs for the consultation: the number of interventions undergone directly affects the choice of surgical method. Clinic contacts and registration are below on the page.
