Urethral Stricture Diagnosis & Treatment

Obstructive urinary symptoms caused by urethral strictures can be extremely serious and have a negative impact on quality of life. They have a wide range of etiologies and degrees of severity. The appropriate course of treatment for urethral strictures should be determined to avoid major consequences on daily activities. In addition to highlighting the need of the interprofessional team in treating patients with urethral strictures, this activity describes the etiology, examination, and management of urethral strictures.

Urethral stricture means the narrowing of the urethra. Scar tissue or tissue inflammation in the affected area are the usual causes of this. A urethral stricture is more likely to form in young men who have undergone hypospadias surgery (a method to treat an undeveloped urethra) and men who have penile implants.

If a patient displays urethral stricture symptoms, it's critical to contact a doctor right once. The most effective approach to prevent significant complications is to address the problem promptly. (1,2)

Definition and Overview

In both men and women, the urethra's main role is to expel urine from the body. Men's ejaculation depends on this little tube in a significant way. A urethral stricture is a scar that restricts or inhibits the flow of urine via this tube as a result of swelling, injury, or infection. Some persons who have urethral strictures complain of pain.

Due to their longer urethras, men are more likely to suffer from urethral disease or damage. Consequently, strictures are more prevalent in men. They are uncommon in women and infants. The urethra can get constricted somewhere between the bladder and the tip of the penis. The flow of urine is restricted or slowed by this constriction. Urethral strictures are generally caused by

• urethral trauma,
• infection, such as a sexually transmitted disease,
• damage from surgical instruments,
• conditions that cause swelling,
• injury from a fall on the scrotum or perineum,
• prostate surgery,
• kidney stone removal,
• urinary catheter.

Procedures

Depending on the size of the blockage and the amount of scar tissue involved, there are numerous options. Without getting treatment, problems with voiding will persist. Infections and stones in the urine and/or testicles could occur. Additionally, there is a chance of urine retention, which can cause enlargement of the bladder and renal issues. 

The treatment procedures for urethral strictures include:

• Dilation

Dilation is usually performed by a urologist with local anesthesia. The stenosis is expanded using larger and larger dilators called "sounds". The tissue can also be stretched using a special balloon on the catheter. Stretching is not a complete treatment, though, therefore it must be practiced frequently. The patient can learn how to periodically insert a catheter to stop the stricture from returning if it does so too quickly. Bleeding and infection are examples of side effects. The stretch can occasionally result in a "false passage" or a second urethral canal.

• Urethrotomy

The stricture is located using a special scope that is moved down the urethra during this procedure. The cystoscope's blade or laser is used to cut through the stenosis and make a cavity. In order to maintain the opening and promote recovery, a catheter may be placed into the urethra. The length of the stricture determines how long it should take to drain a catheter tube.

• Open Surgery

Strictures have been treated using a variety of reconstructive procedures, some of which need only one or two surgeries. The location, length, and severity of the stenosis all play a role in the decision of correction. There are two main types of open surgery including

1. Anastomotic urethroplasty 

It is usually only used for minor urethral strictures. In this instance, the scrotum and the rectum are separated by an incision. After the stricture is resolved, the urethra can be connected again. 

  2.  Substitution urethroplasty

Tissue can be moved to replace the stricture when the stenosis is lengthy. Substitution repairs might need to be done in stages in challenging situations. A urologist with experience in these operations should conduct these repairs. (3)

Candidates

Urethral stricture can cause a number of symptoms that range from mild to severe. Patients with the following symptoms may be considered suitable for the treatment of ureteral stenosis.

• weak urine flow or decreased urine volume
• sudden, frequent urge to urinate
• the feeling of incomplete bladder emptying after urinating
• starting frequently and stopping the flow of urine
• pain or burning when urinating
• inability to control urination (incontinence)
• pain in the pelvic or lower abdomen
• urethral discharge
• penile swelling and pain
• presence of blood in the semen or urine
• darkening of the urine
• inability to urinate (this is very serious and requires immediate medical attention) (4)

Risks and Side Effects

Like any procedure, urethral stricture treatments have risks and side effects. These mainly include

• bleeding,
• impotence, 
• incontinence,
• recurrence,
• urethrocutaneous fistula. (5)

Post-Procedure and Follow-up

Urologists should monitor urethral strictures since they could recur following surgery. The doctor will want to evaluate the patient with a physical examination and any necessary X-rays after the catheter is removed. To check the repair, the doctor will occasionally do a ureteroscopy. The stenosis may recur in some patients, although this may not necessitate further treatment. However, urethrotomy or dilatation can be used to treat it if it is obstructing the urinary tract. For repeated, severe strictures, open surgery can be necessary.

Recovery

After receiving urethral stricture treatment, many patients experience success. Future therapies can also be required if scar tissue causes stenosis.

In some instances, the stricture might result in urinary retention, which is the inability to pee as a result of the urethra's total occlusion. This situation has the potential to be dangerous. A doctor should be contacted right once in the event of stenosis symptoms, including the inability to urinate.

Results

Regular stair climbing and walking are good for better recovery. Patients must avoid sexual activity after the catheter is taken out for a total of six weeks from the operation date. The new tissue that covers the area where the tissue was removed can be obtained in about three weeks and it is possible to slowly return to normal life.