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Urology

Urethral Strictures

Overview

Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.

Risk Factors Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis or benign prostatic hyperplasia (BPH). There is also an increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra ( catheter or cystoscope) increases the chance of developing urethral strictures.

Symptoms

  • Dysuria (painful urination)
  • Difficulty in urinating
  • Urine stream (may develop suddenly or gradually)
  • Spraying of urine stream
  • Decreased urinary output
  • Increased urinary frequency or urgency
  • Incontinence
  • Lower abdominal pain
  • Bloody or dark urine
  • Discharge from urethra
  • Swelling of penis, testes, scrotum
  • Urinary retention
  • Recurrent infections of urinary tract

Investigations To Diagnose Urethral Strictures

  • Urinary flow rate
  • Post-void residual (PVR) measurement
  • Urinalysis
  • Urine culture
  • Tests for Chlamydia and Gonorrhea
  • Retrograde urethrogram to confirm diagnosis
  • Urethroscopy

Treatment For Uretheral Strictures

The treatment comprises of the placement of a suprapubic catheter, which allows the bladder to drain urine through the abdomen. It may be necessary to reduce acute problems such as urinary retention and infection.

Surgical options vary depending on the location and length of the stricture.

Visual internal urethrotomy may be all that is needed for small stricture. A urethral catheter is left in place after the procedure.

Open urethroplasty may be performed for long strictures by removing the affected portion or replacing it with another tissue. The results vary depending on the size and location of stricture, prior therapies and the experience of the surgeon.

There are no drug regimes currently available for urethral strictures. If all other treatment choices fail, urinary diversion -appendicovesicostomy (Mitrofanoff procedure) - may be performed to allow the patient to perform self-catheterization of the bladder through the abdominal wall.

The results of the treatment depend upon the characteristics of the stricture viz. its length, degree of fibres, associated infection, and previous surgeries.

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