Urethral stenosis is a narrowing of a segment of the urethra, which can result in a decrease or even complete interruption of the urinary flow, resulting in a series of complications, explains the best urologist in Delhi.
The urethra is a tubular organ through which urine flows out of the bladder.
In men, the urethra is longer. In its innermost part, just at the exit of the bladder, the urethra crosses the prostate.
Near the exit of the bladder is the urinary sphincter, which controls the voluntary elimination of urine (continence).
Any part of the urethra can be affected, and the extent of the narrowing can vary from a few millimetres or even affect the urethra throughout its length. In general, there is deposition of scar tissue (fibrosis) in the region of the stenosis. This type of problem is more common and more complex in men, says the urologist in Delhi.
- Trauma or urethral lesions that, when healing, can determine an excessive deposition of fibrotic tissue, causing a decrease in the calibre of the urethral canal. There are several types of trauma capable of injuring the urethra: pelvic fractures, “fall to rider” (which occurs, for example, when the person has a bicycle accident and traumatizes the perineum region). Medical procedures with urethral manipulation (cystoscopy, prostate surgery, passage of urethral tubes, among others) and even radiotherapy can also produce strictures, even when done properly, says the urologist in Rohini.
- Infections such as urethritis caused by sexually transmitted diseases (gonorrhoea or chlamydia). Even with the proper treatment and cure of the infection, the healing process resulting from tissue inflammation can cause strictures.
- Congenital – some new-borns are already born with stenosis.
- Cancer is a rare cause of stenosis. The primary tumour is usually located in the prostate or bladder.
- Reduced flow of urine is usually the first symptom. Voiding difficulty is quite common, but complete interruption of flow is rare.
- Spread or double jet.
- Urine drip after urination.
- Increased urination frequency (need to urinate more often than usual).
- Nycturia (waking up and getting up at night to urinate).
- Burning at the time of urination.
- Urinary incontinence in some cases.
When you have a urethral narrowing, the bladder muscle starts to work, making more effort to generate a urinary flow that can overcome the region of stenosis. Even so, depending on the degree of the stenosis, part of the urine may be retained inside the bladder (residual urine). This residue can result in recurrent urinary infections, prostatitis, orchitis (infection of the testicles) and pyelonephritis (infection of the kidneys). An abscess near the site of the stenosis can further aggravate the obstructive condition. Rarely, some patients with chronic inflammation due to urethral strictures can develop cancer, states the best urologist in Pitampura.
Tests for detection of urethral stenosis
- Urofluxometry – Evaluation of the force of the urinary stream, which is obtained when the patient urinates in a device that measures the flow of urine (ml / s). Stenoses determine decreased flow.
- Urethrocystography – Examination in which x-ray plates are made with the urethra filled with contrast. Thus, the location and extent of the narrowing can be determined.
- Cystoscopy – Examining the region of the stenosis with a special endoscope may be indicated in some cases.
- Urethral dilation – Type of outpatient treatment. The region of the stenosis is dilated with the use of progressive gauge plastic urethral tubes. The objective of this method is to try to supply the fibrotic tissue of the stenosis in order to increase / stabilize the internal diameter of the urethral canal. As the urethra is a tubular organ and the scar tissue tends to contract, repeated dilation sessions are generally necessary to maintain the urethral lumen. Some patients learn to self-dilate when the procedure has to be performed at very short intervals. The dilations can be used as an initial treatment in short and mild stenosis, or even in the post-surgical period to stabilize the operated segment, explains the urologist in Pitampura.
- Urethrotomy – A special type of endoscope (called a cystoscope) is introduced through the urethra to the site of the stenosis. A small blade embedded in the device cuts the fibrosis region along the stenotic segment, thereby increasing the light of the urethra. Although most patients improve their symptoms for some time, only about 30% are definitively cured with this type of procedure. Therefore, many end up having to repeat the urethromia from time to time. It is an attractive method because it is performed in a non-invasive endoscopic way. It is more suitable for relatively short strictures (less than 1.5 cm), says the best urologist in Rohini.
- Surgery – It may be an option to the treatments mentioned above. There are several different types of techniques. For relatively short stenoses, the stenosed urethra can be removed and the urethral stumps are again joined with suture points. If the stenosis is long, skin flaps from the region (for example, a foreskin flap) can be rotated to replace the diseased foreskin segment. These procedures have a higher success rate.
- Urethral stents – Used in difficult and complex cases when other types of treatment have had no effect or when the patient’s clinical conditions prevent major surgery. Immediate relief is usually obtained, however, over time, fibrotic tissue progressively surrounds the stent, says the urologist in Delhi.