Urethral stricture
Encyclopedia
A urethral stricture is a narrowing of the urethra
caused by injury or disease such as urinary tract infection
s or other forms of urethritis
.
and the inability to fully empty the bladder. It is not uncommon for the bladder's capacity to significantly increase due to this inability to completely void.
Urethral strictures
may cause problems with urination
, including in certain cases the complete inability to urinate, which is a medical emergency
. Additionally, a urinary tract infection
is often present at, or prior to initial diagnosis. Antibiotics, quinolone
class anti-infective agents, or a combination of trimethoprim/sulfamethoxazole are often employed as the initial stage of treatment. Occasionally, some degree of relief from straining, or improvement of the urinary stream (depending on the severity of the stricture) occurs with antibiotic treatment due to the reduction of urethral inflammation.
Short strictures in the bulbar urethra, particularly between the proximal 1/3 and distal 2/3 of the bulb, may be congenital. They probably form as a membrane at the junction between the posterior and anterior urethral segments. It is not usually noticeable until later in life, as it fails to widen as the urethra does with growth, thus it only impedes urinary flow relative to the rest of the urethra after puberty. Moreover, the patient will often not "know any different", and so will not complain about poor flow.
The urethra runs between the legs very close to the skin, leaving it vulnerable to trauma. Simply falling off a bike and hitting between the legs may result in the formation of scar tissue within the urethra tract. This condition is often not found until the patient has problems urinating because these are painless growths of scar tissue.
Passage of kidney stone
s through the urethra can be painful and subsequently can lead to urethral strictures.
In infants and toddlers, can be as a result of inflammation following a circumcision and not noticeable until toilet training when a deflected stream is observed or when the child must strain to produce a urinary stream.
, including patient instruction/education on detection of the symptoms of UTI and undergo a non-invasive Uroflowmetric Study at annual intervals for at least five years (post surgery). Additionally, after age 40, it is recommended that the prostate
be monitored (in males) at intervals as determined by the physician/practitioner overseeing the situation. Although no formal studies are available documenting this, there appears to be a slightly higher incidence of prostatitis
in stricture patients versus the general population. Patient education and counseling is an important aspect of the successful resolution, and continued care for the stricture patient.
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
caused by injury or disease such as urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
s or other forms of urethritis
Urethritis
Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination.-Causes:The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis , most commonly caused by Chlamydia trachomatis...
.
Signs and symptoms
During the early stages of the condition, the subject may experience pain during urinationDysuria
In medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
and the inability to fully empty the bladder. It is not uncommon for the bladder's capacity to significantly increase due to this inability to completely void.
Urethral strictures
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
may cause problems with urination
Urination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
, including in certain cases the complete inability to urinate, which is a medical emergency
Medical emergency
A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...
. Additionally, a urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
is often present at, or prior to initial diagnosis. Antibiotics, quinolone
Quinolone
The quinolones are a family of synthetic broad-spectrum antibiotics. The term quinolone refers to potent synthetic chemotherapeutic antibacterials....
class anti-infective agents, or a combination of trimethoprim/sulfamethoxazole are often employed as the initial stage of treatment. Occasionally, some degree of relief from straining, or improvement of the urinary stream (depending on the severity of the stricture) occurs with antibiotic treatment due to the reduction of urethral inflammation.
- Obstructive voiding symptoms namely:
- Decreased force of urinary stream
- Incomplete emptying of the bladder
- Urinary terminal dribbling
- Urinary intermittency
- Deflected urinary stream
- Increased frequency of micturition
- Acute or chronic retention of urine
- Hydronephrotic signs due to back pressure
Complications
- Urinary retentionUrinary retentionUrinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
- Urethral diverticulumDiverticulumA diverticulum is medical or biological term for an outpouching of a hollow structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false....
- Periurethral abscess
- Urethral fistula
- Bilateral hydronephrosisHydronephrosisHydronephrosis is distension and dilation of the renal pelvis calyces, usually caused by obstruction of the free flow of urine from the kidney, leading to progressive atrophy of the kidney...
- Urinary infections
- Urinary calculusCalculusCalculus is a branch of mathematics focused on limits, functions, derivatives, integrals, and infinite series. This subject constitutes a major part of modern mathematics education. It has two major branches, differential calculus and integral calculus, which are related by the fundamental theorem...
- HerniaHerniaA hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....
, haemorrhoids or Rectal prolapseRectal prolapseRectal prolapse normally describes a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body.-Types:There are three chief conditions which come under the title rectal prolapse:...
from straining
Causes
Urethral strictures are generally caused by either injury-related trauma to the tract or by a viral or bacterial infection of the tract, often caused by certain sexually transmitted infections (STIs). The body's attempt to repair the damage caused by the injury or infection creates a buildup of scar tissue in the tract resulting in a significant narrowing or even closure of the passage. Instrumentation of the urethra, particularly before the advent of flexible uro-endoscopy, was (and remains) an important causative event.Short strictures in the bulbar urethra, particularly between the proximal 1/3 and distal 2/3 of the bulb, may be congenital. They probably form as a membrane at the junction between the posterior and anterior urethral segments. It is not usually noticeable until later in life, as it fails to widen as the urethra does with growth, thus it only impedes urinary flow relative to the rest of the urethra after puberty. Moreover, the patient will often not "know any different", and so will not complain about poor flow.
The urethra runs between the legs very close to the skin, leaving it vulnerable to trauma. Simply falling off a bike and hitting between the legs may result in the formation of scar tissue within the urethra tract. This condition is often not found until the patient has problems urinating because these are painless growths of scar tissue.
Passage of kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
s through the urethra can be painful and subsequently can lead to urethral strictures.
In infants and toddlers, can be as a result of inflammation following a circumcision and not noticeable until toilet training when a deflected stream is observed or when the child must strain to produce a urinary stream.
Diagnosis
- CystoscopyCystoscopyCystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
- Urethrography
Instrumental treatment
- Urethral Dilatation with urethral sounds or filiform catheter (at prescribed intervals depending upon the severity and location of the stricture and the age/health of the patient) (office procedure - topical anesthetic)
- Bougies of increasing size (gum, elastic, continuous dilatation) (this is a seldom used method/treatment modality due to the increased possibility of infection, discomfort, and time involved)
- PRNPro re nataPro re nata is a Latin phrase meaning "in the circumstances" or "as the circumstance arises". It is commonly used in medicine to mean "as needed" or "as the situation arises." It is generally abbreviated to p.r.n. in reference to dosage of prescribed medication that is not scheduled; instead...
Urethral Dilatation, usually every three to six months (office procedure - topical anesthetic)
Emergency treatment
- Dilatation with filiform and followers, and drainage of the urinary bladder through the follower catheter/lumen (Emergency DepartmentEmergency departmentAn emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
or office-based procedure) - Cystoscope guided insertion of filiform and followers, and drainage of the urinary bladder through the follower catheter/lumen (Emergency DepartmentEmergency departmentAn emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
or office-based procedure) - Visual Internal UrethrotomyUrethrotomyA urethrotomy is an operation which involves incision of the urethra, especially for relief of a stricture. It is most often performed in the outpatient setting, with the patient being discharged from the hospital or surgery center within six hours from the procedure's inception.Urethrotomy is a...
with placement of Foley catheterFoley catheterA Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
and urinary drainage system for 7 days post-procedure (Operating Room based procedure under local or general anesthesia) - Insertion of a suprapubic catheter with catheter drainage system (prior to surgical resolution) (Operating Room, Emergency DepartmentEmergency departmentAn emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
or office-based procedure)
Surgery
- Visual internal urethrotomyUrethrotomyA urethrotomy is an operation which involves incision of the urethra, especially for relief of a stricture. It is most often performed in the outpatient setting, with the patient being discharged from the hospital or surgery center within six hours from the procedure's inception.Urethrotomy is a...
- Laser ablation urethrotomyUrethrotomyA urethrotomy is an operation which involves incision of the urethra, especially for relief of a stricture. It is most often performed in the outpatient setting, with the patient being discharged from the hospital or surgery center within six hours from the procedure's inception.Urethrotomy is a...
- Single-Stage urethroplastyUrethroplastyA urethroplasty is an operation for the repair of an injury or a defect in the walls of the urethra. Commonly, this involves removal and end-to-end anastomosis for shorter strictures or grafting using buccal mucosa for longer ones....
(Penile flap or buccal mucosal graft) - Multiple-Stage urethroplastyUrethroplastyA urethroplasty is an operation for the repair of an injury or a defect in the walls of the urethra. Commonly, this involves removal and end-to-end anastomosis for shorter strictures or grafting using buccal mucosa for longer ones....
(Anastomotic urethroplasty) - Johanson's urethroplastyUrethroplastyA urethroplasty is an operation for the repair of an injury or a defect in the walls of the urethra. Commonly, this involves removal and end-to-end anastomosis for shorter strictures or grafting using buccal mucosa for longer ones....
(limited to the most severe cases, usually for traumatic stricture) - Temporary urethral stent placement
- Permanent urethral stent placement
Ongoing care
Because of the high rate of recurrence, Urethral Stricture Disease is often a lifetime-long diagnosis, even after successful surgical resolution of the stricture. Patients should be monitored (and treated) for urinary tract infectionUrinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
, including patient instruction/education on detection of the symptoms of UTI and undergo a non-invasive Uroflowmetric Study at annual intervals for at least five years (post surgery). Additionally, after age 40, it is recommended that the prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
be monitored (in males) at intervals as determined by the physician/practitioner overseeing the situation. Although no formal studies are available documenting this, there appears to be a slightly higher incidence of prostatitis
Prostatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
in stricture patients versus the general population. Patient education and counseling is an important aspect of the successful resolution, and continued care for the stricture patient.