What is a URETHRAL STRICTURE
The Urethra provides the flow of urine from the bladder to the tip of your penis and out. This tube is a vital transportation line to remove urine from your bladder and kidneys and in normal circumstances, provides an unrestricted flow of urine. Individuals suffering from a urethral stricture disease find this flow to be obstructed meaning that they experience a lack of strength of flow, a reduction in the amount of urine expressed and a strain when attempting urination.
Causation
While described as a disease, there is no infection or bacteria that causes this condition. Typical reasons for the development of urethral strictures include the following:
- Injury
The cause of this ‘disease’ is usually from an injury as a child through sports or other activities that have created damage in the urethra. The damage is usually located in the bulbar part of the urethra and the individual may not have realised at the time as the urethra stricture injury usually develops many months to years after the injury.
- Pelvic Fractures
This injury is often experienced in traffic trauma and other such crush type injuries and can lead to a tear in the membranous portion of the posterior urethra leading to complete blockage of urination.
- Hypospadias
Children born with an underdeveloped urethra, called a Hypospadias, may develop a urethra stricture from the healing of the surgical area where treated.
- Catheters or other foreign items placed near the urethra
In some surgical procedures, cancer treatments or implant treatments, a side effect may include damage to the urethral structure. This can lead to the development of a urethral stricture.
Consequences
The inability to drain the waste urine from the bladder can lead to serious repercussions. Urine is a waste product and retention in the bladder can lead to infection. The strain of attempting to urinate can herniate the bladder.
Continual lack of emptying the bladder can lead to enlargement and then an inability to control the urine removal. A breakdown in the control of the bladder can lead to further urine problems, frequent day or night urination requirements, urination requirements with little or no warning or incontinence. Sperm flow also travels through the urethra and if the full evacuation is not made of this, blockage can be created and lead to conditions such as infections of the prostate (called Prostatitis), the epididymis (called Epididymitis) or the testicle (called Orchitis) if urine flows back to the prostate or other organs.
If urine is forced into a ‘reverse’ flow, urine can return to the kidneys which can, in turn, lead to kidney stones and potentially, irreversible damage to the kidneys such as renal failure.
Treatment Options
Talking to our experts at International Andrology is the first step in seeking help and support to treat this complex ‘disease’. The first step is to diagnose the urethral stricture, locate it accurately and then treat it.
Unfortunately, for most patients, the only treatment option for urethral stricture is a surgical reconstruction, called urethroplasty.
- Urethroplasty Procedure
Urethroplasty is the surgical procedure to reconstruct and correct a Urethral Stricture. This includes removing the involved segment and reattaching the two normal ends. This procedure is called excision and also a primary anastomosis. Patients with short strictures which may involve the bulbar or membranous urethra, in particular, respond best to this procedure. In cases where a repair to this system is not available, certain tissues can be transferred in augment, enhance and widen the narrow area of the stricture to a more normal width. Penile skin and other sources such as inside the cheek can be utilised to reconstruct the Urethra. Other procedures such as a two-stage repair using cheek tissue and or possible split thickness grafts can be placed in the undersurface of the penis then rolled into a new Urethra and can be utilised when the other described treatment options are not viable or recommended. These options can be discussed with your medical expert to decide the best method for treating this condition.
- Recovery after surgery
Urethroplasty can be complex but recovery in the hospital does not usually exceed 5 days inpatient treatment and in most cases, patients can leave the hospital the same day of their operation. There can be some soreness from areas of skin graft although the concentrated areas of treatment such as the penis and scrotum do not usually display pain after the procedure. Pain medication usually enhances the healing path and soft diets are usually recommended for those with cheek grafted areas to not antagonise the healing area. A period of healing inactivity of 2-3 weeks is recommended for the preceding weeks after surgery and after this period of time, any catheter implanted to enhance healing. The catheter also works to provide doctors with an X-ray gateway to view the surgical area and the healing after.
Many patients report a vast change in their ability to urinate after the procedure, with the flow and speed often much more impressive after.
- Follow-Up procedures
4 months after the surgical procedure, a follow-up appointment is recommended to undergo a Urethroscopy to view the healed area, check for the enhances in before and after ability and confirm the changes that have taken place in their urethra.
If there is any further treatment required, on the recommendation of our doctors, the patient and doctor will address these and evaluate the best way forward for this.
I am suffering from a Urethral Stricture, what should I do next?
If you believe you are suffering from urethral problems and it causes you significant concern we advise you to see a specialist urologist/andrologist.
Our doctors have vast experience treating this condition and our clinic is an international referral centre for patients looking for treatment. We would be happy to review your case and treat you in our clinic.