URETHRAL STRICTURE (DISORDER OF THE URINARY TRACT)

WHAT IS URETHRA?

Urethra is a tube that carries out urine from the body of both male and female found in the urinary system, it connects the bladder to the urinary meatus for the removal of urine from the body.

In male the urethra is longer than in females, the urethra also serves as a route of passage of semen for men. The main responsibility of urethra is for the passage of urine.

WHAT IS URETHRAL STRICTURE

Urethral stricture also known as stenosis, is a disorder of the male urinary system in which there is chronic fibrosis and narrowing of the urethral lumen of the male genitalia resulting to the blockage of the pathway for urine outflow. It causes variety of medical problems including infection and inflammation.

It causes difficulty and pain during urination, causing urine to back up in the urinary tract. It happens at any point from the bladder to the tip of the penis, which can lead to kidney damage.

CAUSES OF URETHRAL STRICTURE     

The causes of the urethral stricture are listed below:

  1. Straddle injury (falling from a motorcycle or hitting the scrotum on a hard surface)
  2. Medical procedure that involves insertion of an instrument, such as an endoscope that is bigger than the width of the urethra
  3. Long term use of indwelling urinary catheter
  4. External injuries like pelvic fractures which can partially or completely sever the membranous urethra and cause severe and complex strictures
  5. Trauma to the pelvis
  6. An enlarged prostrate or history of prostatectomy.
  7. Sexually Transmitted Infections such as gonorrhea and chlamydia and a condition called balanitis xerotica obliteranss.
  8. Radiation Therapy
  9. Correction of hypospadias (it is a congenital abnormality in which there is abnormal opening in the underside of the penis)

SYMPTOMS OF URETHRAL STRICTURE

The symptoms of urethral stricture are:

  1. Blood in the semen
  2. Pain during urination
  3. Swelling of the penis
  4. Bloody or dark urine
  5. Urinary retention
  6. Pain in the lower abdominal area or pelvic area
  7. Loss of bladder control
  8. Slow urge to urinate
  9. Prostatitis: Inflammation of the prostate gland 

DIAGNOSIS OF URETHRA STRICTURE

Urethra stricture can be diagnosed in the following ways listed below:

  1. History taking: the history examination includes asking questions regarding to any occurrence of urethral stricture and preoperative erectile function and urinary continence. In history examination questions regarding medical, social and family history are asked.
  2. Physical examination: it includes the abdominal examination, genital examination, assessment of lower extremity mobility for operative positioning and digital rectal examination.
  3. Urine culture is needed to detect if there is presence of infection in the urine
  4. Retrograde urethrography
  5. Cystoscopy and urethroscopy: it allows the visualization of the stricture by the passage of a viewing instrument inside the urethra, ensuring that the individual is locally anaesthetized so as to reduce the pain during the procedure. It is done to view the location, extent and degree of scarring of the urethra.
  6. Urethrogram or voiding cystourethrogram (X-ray): is done to detect the extent of damage caused by the stricture, sometimes vesicle stones, trabeculations, or diverticula may also be seen.
  7. Rectal examination and Panendoscopy: This is a differential diagnosis used in detecting abnormality with the prostate gland. Panendoscopy is a procedure done to detect the point of narrowness and disclose evidence of urethritis

TREATMENTS OF URETHRAL STRICTURE

Urethral stricture can be treated using the following options listed below:

  1. Dilation of the urethra:  it is a procedure done when the doctor inserts a dilator in the urethra to dilate and enlarge the urethra; this procedure is done under anesthesia to reduce pain felt.
  2. Visual urethrotomy: this is done after urethra dilation has been carried out, then it proceeds to visual urethrotomy when a cystoscope is used with a special tool to cut the ring of scar tissue and open the area of blockage.
  3. Anastomotic urethroplasty: this procedure is done by doing the single stage open surgical repair by making use of a buccal mucosa graft, or penile flap to repair the stenosis.

PREVENTION OF URETHRAL STRICTURE

It is recommended to avoid straddle injuries or pelvic injuries that could lead to the occurrence of urethral stricture, also if there is an infection it is strongly recommended it is treated completely to prevent urethral stricture.

COMPLICATION OF URETHRAL STRICTURE

The complications that can arise from urethral stricture are listed below and could be life threatening:

  1. Renal failure: this can happen because of the inability of the man to pass out urine, which causes retention of urine and consistent retention of urine damages the kidney.
  2. Hydronephrosis: it is a condition in which there is excess accumulation of urine in the pelvis and calyces of the kidney, which causes swelling of the kidney leading to pain during urination, incomplete voiding and vomiting.
  3. Bladder diverticula
  4. Periurethral abscesses: Periurethral abscess is the abscess or pus formation seen on the urethra which connects the genitals with the bladder.
  5. Cystitis: inflammation of the bladder
  6. Urethrocutaneous fistulas: it is abnormal adhesion of a body structure to the urethra.
  7. Urethral carcinoma
  8. Vesical calculi: it occurs due to increased urinary concentration in individual causing stones in the urinary system
  9. Ejaculatory Dysfunction: it is when a man does not have the ability of ejaculating

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