Urethral stricture (ICD 10 N 35) is a narrowing of the urethra, which does not depend on any reason and leads to a violation of the normal outflow of urine from the bladder. We will discuss the symptoms and treatment of the disease below.
Symptoms of pathology
Symptoms of urethral stricture can manifest themselves in the following sensations:
- It makes it difficult to start urinating.
- Sensation of pain during urination.
- Feeling of incomplete emptying of the bladder.
- Decreased urinary pressure.
- The presence of smudges of urine.
- Spraying along with bifurcation of a stream of urine.
- The development of hematuria - blood in the urine.
- Observation of blood in semen.
- Sensation of pain in the lower abdomen.
- The appearance of discharge from the urethra.
- Weakening ejaculation - the release of seminal fluid during sexual intercourse from the urethra.
Forms of ailment
For reasons of appearance, a congenital and acquired form of this pathology is isolated. The acquired type of urethral stricture occurs immediately after the birth of a person and can be traumatic, inflammatory or iatrogenic in nature, which, as a rule, arises as a result of certain medical manipulations.
In its course, the disease can be primary (occurring the first time), recurrent (reappearance), or complicated.
Possible locations of localization:
- The anterior urethra. In this case, part of the urethra is located in the penis.
- The posterior urethra, when part of the urethra, is in close proximity to the bladder.
According to the length of the urethral stricture may have a short shape (up to one centimeter) and long (more than one centimeter).
Causes
Congenital urethral stricture is caused by defects obtained from birth, which are expressed in narrowing of the urethra. Acquired forms of pathology are due to several reasons. Most often this happens due to various injuries:
- Getting blunt injuries in the perineum due to shock, fall, and so on.
- Penetrating wounds in the form of knife, gunshot injuries, as well as bites.
- As a result of sexual excesses - the presence of foreign bodies in the urethra along with fractures of the penis, which in turn can be accompanied by severe pain, and, in addition, profuse internal bleeding.
- Pelvic fracture due to car injuries, falls from a height and so on.
- The chemical and thermal nature of urethral damage through substances used for the treatment.
In addition, this pathology may occur due to the presence of inflammatory processes in the urethra, that is, with urethritis. Post-radiation urethral strictures in men and women, which arise as complications after radiation treatment aimed at the use of radiation for the treatment of tumor neoplasms, also cause this pathology. Other provoking factors include the following reasons:
- The presence of iatrogenic causes, which are caused by the careless performance of urological manipulation and surgery.
- The presence of concomitant abnormalities in diseases that are accompanied by a deterioration in the metabolism and blood supply to the tissues of the urethra, we are talking about diabetes mellitus, arterial hypertension and coronary heart disease.
Diagnosis of the disease: history taking
As part of diagnostic measures, in order to determine subsequent treatment, the following tests and procedures are prescribed to patients:
- Gathering an anamnesis of the disease, as well as complaints about the appearance of the first symptomatology, its development and so on.
- An analysis of the history of life. In this case, the risk factors for the appearance of the disease are identified. In particular, the appearance of infectious pathologies of the urogenital system along with their frequency is analyzed, various injuries in the perineum, pelvic fractures, and so on are also taken into account.
- Inspection at the urologist.
- Conducting a digital rectal examination of the prostate gland. As part of this diagnostic method, the index finger is inserted into the rectum, after which the prostate is felt. This technique makes it possible to evaluate in detail the size along with general soreness and the shape of the organ.
Laboratory research
Among other things, urologists with urethral stricture in men carry out laboratory tests of smears that are taken from the urethra in order to determine the presence of certain genital infections. This is done through the following methods:
- Direct immunofluorescence is a method for the direct detection of antigens. A particular substance, considered by the human body as foreign or potentially dangerous, is taken for the enemy and the development of protective proteins begins against it. It is the amount of these proteins that determines this research analysis, which is performed using a luminescent microscope equipped with a special light filter.
- The polymerase chain reaction is nowadays considered to be a highly accurate diagnostic method that allows detecting deoxyribonucleic acid - a structure that provides storage and implementation of genetic programs of living organisms. Thanks to this method, it is possible to detect the pathogen of one or another pathology.
- Bacteriological culture is a laboratory study in which the biomaterial is placed in a favorable environment for it, where microbial growth occurs. This method makes it possible to determine the degree of sensitivity of microorganisms to antibiotics.
Alternative diagnostic methods
In addition to the above methods, the following diagnostic options are performed for urethral stricture:
- Submission of a general urine test, which makes it possible to detect an excess level of protein along with white blood cells, red blood cells and pus.
- Carrying out uroflowmetry, in the framework of which the urine flow rate is measured by means of a special apparatus, which makes it possible to assess the severity of urination disorders.
- An ultrasound examination of the bladder. This procedure is performed, as a rule, immediately after urination, which makes it possible to determine the level of residual urine, having received an idea of violations of various functions.
- Ultrasound examination of the kidneys, allowing you to get an image of the organ in order to assess the presence of certain changes.
X-ray contrast methods for diagnosing the disease
This method allows you to assess the localization along with the length of the urethral stricture (ICD N 35), determining the presence of false passages, diverticula, and, in addition, the presence of stones, including in the bladder. In this case, the technique is as follows:
- Conducting retrograde urethrography, in which a contrast agent is injected into the urethra through an external opening. This method makes it possible to evaluate a site with a length of narrowing of the urethra.
- Carrying out intravenous urography. In this case, a radiopaque substance is injected into the patient's vein, which after three minutes begins to be excreted by the kidneys. At this point, specialists take x-rays, which are taken at certain intervals. Further, when the drug is completely excreted by the kidneys, leaving the bladder, take a picture of the urethra at the moment when the patient will urinate. This method makes it possible to assess renal function along with the condition of the bladder, and, in addition, to identify a place with a length of urethral stricture.
- Carrying out multispiral computer cystourethrography. As part of this procedure, a contrast agent is injected into the vein of the patient, which after three minutes begins to be excreted through the kidneys. Further, as soon as the entire drug is secreted and leaves the bladder, computed tomography is performed, which allows layer-by-layer to see tissue. Computed tomography is done at a time when the patient is urinating. This technology is the most informative study, allowing you to get a reconstruction of the entire picture of the urethra.
Methods of endoscopic diagnosis
This type of diagnosis allows you to examine the area of stricture of the urethra, due to which it is possible to establish the possible causes of the disease and perform a tissue biopsy for subsequent research. As part of this method, the following procedures are carried out:
- Cystoscopy, which serves as a study of the bladder through a special tool. This instrument is a cystoscope with an optical system integrated into its metal casing.
- Urethroscopy, which is the examination and examination of the urethra, is also done with this tool.
What is the treatment for urethral stricture in men?
Treatment
The following treatment options are being taken to treat this disease:
- Urethral dilatation, in which special bougie-dilators are used, which are smooth metal or plastic rods that can expand balloon catheters. Such catheters, in turn, is a flexible tube with a can at the end. Thanks to this device, the scar area is stretched, in which there was a narrowing after the operation of urethral stricture.
- Urethrotomy, in which an internal incision is made of a narrowed section of the urethra using endoscopic instruments, which are a flexible tube along with an integrated optical system that allows you to make microscopic incisions on the skin. What else does treatment of urethral stricture in men mean?
- Carrying out stenting of the urethra. As part of this procedure, a special spring is inserted into the urethral lumen using endoscopic instruments.
- Performing a cystostomy. This procedure involves puncture of the bladder with subsequent installation of the tube into its lumen in order to divert urine. Use this technique in case of development of a complete urinary retention. Treatment for urethral stricture is not limited to this.
- Open surgery on the urethra. In this case, parts of the urethra can be removed, after which the ends of the urethra are sutured. In the event that the narrowing is long, then immediately after removal of the site, in order to replace the defect, the patient’s own mucosa or lips are used.
Laser treatment of urethral stricture
For endoscopic treatment of strictures, various surgical lasers are used.
The most commonly used neodymium laser. It has a simple and compact design, good radiation power.
Internal laser urethrotomy is performed according to the classical method of optical urethrotomy, when a scar ring is cut through a circle of a stricture in one place using a laser beam. There should be no deep penetration of the optical fiber into the scar tissue, as this can cause coagulation of healthy tissues.
Strictures more than 1 cm long are treated with a technique in which coagulation of scar tissue in several places is performed.
Possible complications and consequences
Against the background of the development of this disease, the following complications may threaten the patient:
- The appearance of urinary tract infections in the form of cystitis, prostatitis, pyelonephritis or orchitis.
- The formation of stones and, as a result, urolithiasis.
- Complete blockage along with the impossibility of outflow of urine.
- The development of hydronephrosis, which is a progressive expansion of the pyelocaliceal system, which leads, as a rule, to pronounced impaired renal function.
- The formation of kidney failure.
The complications after surgery for urethral stricture include the following:
- The development of relapse - the reappearance of pathology and the development of bleeding.
- The process of transudation, against which the surrounding tissues are saturated with blood.
- Penis enlargement with a sharp increase in elasticity, which subsequently will contribute to the replacement of spongy tissue with connective tissue.
- The displacement of the installed stent, which will cause severe pain during intercourse and in a sitting position.
Pathology Prevention
In order to carry out prevention, it is necessary to monitor the danger of acquiring sexually transmitted diseases. In this regard, it is required to abandon random connections, and, in addition, use barrier methods of contraception. So that this unpleasant disease does not occur, it is equally important to observe the rules of personal hygiene in the process of intimate life. As part of this recommendation, genital hygiene should be regularly performed immediately after completion of sexual intercourse. Use only an individual towel. A routine examination by a urologist along with an examination for sexually transmitted diseases should be performed by men at least once a year.
It is extremely important to conduct timely treatment of urethritis in the event that its symptoms appeared in men. Urethral stricture then does not occur. Doctors should be careful during endourethral procedures. In addition, men should avoid injuries and other adverse factors, such as, for example, hypothermia.