Urethral stricture is a common problem recently. The most common symptom of urethral stricture is making urine drop by drop.
What is Urethral Stricture?
The urethra is the last organ of the urinary excretory system, which contains the muscles, mucous membranes, and nerves required for the discharge of urine from the bladder.
In men, the part after the prostate is used jointly with the semen. In other words, after the prostate, both semen and urinary tract are common. The narrowing of this path due to a number of reasons, namely the narrowing of the urethra, is called urethral stricture.
The urethra is 20-25 cm in adult males and 3-5 cm in females. Since it is long in men, strictures are most common in men.
What Causes Urethral Stricture?
Urethral stricture can be seen at any age. The urethral mucosa is highly sensitive and responds to injuries with stricture. Causes are;
- Urological infections: It is known as the most common cause of stenosis. Infections in the external urinary tract disrupt the structure of the urethral mucosa, even if the infection heals, stenosis occurs due to the sequelae in the urethra.
- Catheter insertion: Probes inserted to empty the urinary bladder cause injuries to the urethra and subsequent injury.
- Traffic accidents: Strictures may develop due to urethral injuries in traffic accidents. In severe injuries, the urethra ruptures completely and the patient cannot urinate.
- Endoscopic surgical procedures used in urology: In prostate, bladder, ureter and kidney stone surgeries, strictures may develop due to endoscopic instruments injuring the urethra.
- Unknown (idiopathic) reason
- Other causes: foreign body insertion into the urethra due to psychological problems, penis fractures accompanied by urethral trauma
What are the Symptoms of Urethral Stricture?
When the urethra is narrowed, the patient cannot urinate comfortably. The urine accumulated in the bladder cannot be emptied sufficiently.
The urinary bladder thickens, its content increases, if the discharge cannot be performed further, the urine goes back to the kidneys from the bladder, and the urine becomes unavailable in the kidney.
Infection occurs in the accumulated urine, which can be serious problems leading to kidney inflammation and eventually kidney failure.
In case of urethral stricture, serious symptoms such as making the urine too thin, frequent urination, incomplete urination, drop-by-drop urination, bifurcation in the urine, burning in the urine are observed.
If left untreated, it can lead to serious problems, eventually leading to kidney failure.
How Is Urethral Stricture Diagnosed?
If there are symptoms, a urinalysis, urine culture, blood creatinine level should be checked first. Later, urinary tract ultrasonography and uroflowmetry tests should be performed.
When necessary, urethrography examination should be performed by giving medicated fluid to the urinary tract. As a result, urethral stricture is diagnosed, and the location and length of the stricture are determined. Computed tomography may be required in severe traumas.
How Is Urethral Stricture Treated?
The treatment method is chosen after the diagnosis, level, degree and location are determined. First of all, the preference should be to open the stenosis endoscopically. However, if the stenosis is in the form of complete obstruction, then the narrow part can be removed with open surgery and the urethra can be connected end to end.
The most important disadvantage of endoscopic urethrotomy surgery is the recurrence of the stenosis at a rate of approximately 50%. Therefore, when the stenosis recurs, one should not insist on endoscopy.
If necessary, the narrow part should be removed and tied end to end with open surgery. In some cases, a piece of oral mucosa is taken and placed in the urethra. The treatment and surgery of urethral strictures in the bladder outlet and prostate are very difficult.
It can cause serious complications such as urinary incontinence and erectile dysfunction. Urethral strictures in the penis can be treated more easily.