Urethral stricture (ICD 10 N 35) is a narrowing of the urethra, which does not depend on any cause and leads to a violation of the normal outflow of urine from the bladder. We will talk about the symptoms and treatment of the disease further.
Symptoms of pathology
Symptoms of urethral stricture may include:
- Difficulty starting to urinate.
- Feeling sore when urinating.
- Feeling of incomplete bladder emptying.
- Decreased urinary pressure.
- Presence of urine leaks.
- Spray along with bifurcation of the urine stream.
- Development of hematuria - blood in the urine.
- Seeing blood in semen.
- Feeling pain in the lower abdomen.
- Appearance of discharge from the urethra.
- Weakening of ejaculation - the release of seminal fluid during sexual intercourse from the urethra.
Forms of illness
For reasons of occurrence, congenital and acquired forms of this pathology are distinguished. Acquired type of urethral stricture occurs immediately after birtha person and can be traumatic, inflammatory or iatrogenic in nature, which, as a rule, occurs as a result of certain medical manipulations.
According to its course, the disease can be primary (appearing for the first time), recurrent (reappearance) or complicated.
Possible locations:
- Anterior urethra. In this case, part of the urethra is in the penis.
- Posterior urethra, when part of the urethra is in close proximity to the bladder.
According to the length, the urethral stricture can be short (up to one centimeter) and long (more than one centimeter).
Reasons
Congenital urethral stricture is caused by birth defects that result in a narrowing of the urethra. Acquired forms of pathology are explained by several reasons. Most often this happens due to various injuries:
- Obtaining blunt injuries in the perineal area due to impact, falling and so on.
- Penetrating stab wounds, gunshot wounds, and 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 accidents, falls from heights, etc.
- Chemical and therm althe nature of the damage to the urethra by the substances used for the purpose of treatment.
In addition, this pathology may occur due to the presence of inflammatory processes in the urethra, that is, with urethritis. Post-radiation strictures of the urethra in men and women, which occur as complications after radiation treatment aimed at the use of radiation for the treatment of tumor neoplasms, also causes the appearance of this pathology. Other provoking factors include the following reasons:
- The presence of iatrogenic causes, which are caused by the careless performance of urological manipulations and operations.
- The presence of concomitant abnormalities in diseases that are accompanied by a deterioration in metabolism and blood supply to the tissues of the urethra, we are talking about diabetes, hypertension and coronary heart disease.
Diagnosis of the disease: taking anamnesis
As part of a diagnostic exercise, the following tests and procedures are ordered for patients to determine their next treatment:
- Collecting an anamnesis of the disease, as well as complaints about the appearance of the first symptoms, its development, and so on.
- Conducting a life history analysis. In this case, risk factors for the onset of the disease are identified. In particular, the appearance of infectious pathologies of the organs of the genitourinary system is analyzed along with their frequency, various injuries in the perineal region, fractures of the pelvic bones, and so on are also taken into account.
- Passing an examination by a urologist.
- Carrying out 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 assess in detail the size along with the general soreness and shape of the organ.
Laboratory studies
Among other things, urologists with urethral stricture in men conduct laboratory tests of swabs taken from the urethra in order to determine the presence of certain sexual infections. This is done through the following methods:
- Direct immunofluorescence is a method for the direct detection of antigens. This or that substance, considered by the human body as alien or potentially dangerous, is taken as an enemy and the production of protective proteins begins against it. It is the amount of these proteins that determines this research analysis, which is performed using a fluorescent microscope equipped with a special light filter.
- Carrying out the polymerase chain reaction is considered today a highly accurate diagnostic method that allows detecting deoxyribonucleic acid - a structure that provides storage and implementation of the genetic programs of living organisms. Thanks to this method, it is possible to detect the causative agent of a particular pathology.
- Bacteriological seeding is a laboratory study in which the biomaterial is subjected to placement in a favorable environment for it, where growth occursmicrobes. 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 options for diagnosing urethral stricture are carried out:
- Performing a general urinalysis, which makes it possible to detect excess protein along with white blood cells, red blood cells and pus.
- Uroflowmetry, which measures the speed of urine flow using a special device that makes it possible to assess the severity of urination disorders.
- 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, getting an idea of violations of various functions.
- Ultrasound examination of the kidneys, which allows you to get an image of the organ in order to assess the presence of certain changes.
X-ray contrast methods for diagnosing a 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:
- Retrograde urethrography, in which a contrast agent is injected into the urethra through the external opening. This method makes it possible to estimate the place with the length of the narrowingurethra.
- 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, X-rays are taken by specialists, which are taken at certain intervals. Further, when the drug is completely excreted by the kidneys, having entered the bladder, a picture of the urethra is taken at the moment when the patient urinates. This method makes it possible to evaluate the function of the kidneys along with the state of the bladder, and, in addition, to identify the place with the extent of the urethral stricture.
- Carrying out multislice computed cystourethrography. As part of this procedure, a contrast agent is injected into the patient's vein, which, after three minutes, begins to be excreted through the kidneys. Further, as soon as all the drug is released and released into the bladder, computed tomography is performed, which allows you to see the tissue in layers. A CT scan is done while the patient is urinating. This technology is the most informative study that allows you to get a reconstruction of the entire picture of the urethra.
Endoscopic Diagnosis Methods
This type of diagnosis allows you to examine the area of urethral stricture, which makes it possible to establish the possible causes of the disease and perform a tissue biopsy for further research. As part of this method, the following procedures are carried out:
- Cystoscopy, which serves as an examination of the bladder throughspecial tool. This instrument is a cystoscope, which has an optical system built into the metal case.
- Ureteroscopy, which is the examination and examination of the urethra, is also done with this instrument.
How is urethral stricture treated in men?
Treatment
The following therapies are being undertaken to treat this disease:
- Urethral dilatation, which uses special bougie dilators, which are smooth metal or plastic rods that can expand balloon catheters. Such catheters, in turn, is a flexible tube with a balloon 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 in the narrowed portion of the urethra using endoscopic instruments, which are a flexible tube along with a built-in optical system that allows making microscopic incisions in the skin. What else is involved in the treatment of urethral stricture in men?
- Stenting of the urethra. As part of this procedure, a special spring is inserted into the lumen of the urethra using endoscopic instruments.
- Performing a cystostomy. This procedure involves puncturing the bladder and then inserting a tube into its lumen to drain urine. Use this technique in case of development of complete urinary retention. Stricture treatmenturethra is not limited to this.
- Performing 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 extended, then immediately after the removal of the area, in order to replace the defect, the patient's own mucous membrane of the cheeks or lips is used.
Urethral stricture laser treatment
A variety of surgical lasers are used in the endoscopic treatment of strictures.
The most commonly used neodymium laser. It has a simple and compact structure, good output power.
Internal laser urethrotomy is performed according to the classical method of optical urethrotomy, when the laser beam cuts the scar ring along the circumference of the stricture in one place. There should not be a deep penetration of the optical fiber into the scar tissue, as this may cause coagulation of he althy tissue.
Strictures over 1 cm long are treated with a technique that coagulates scar tissue in multiple locations.
Possible complications and consequences
Against the background of the development of this disease, the patient may face the following complications:
- 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 inability to drain urine.
- Development of hydronephrosis, which is a progressive expansion of the pelvicalycealsystem, which leads, as a rule, to a pronounced impairment of kidney function.
- Formation of kidney failure.
Complications after urethral stricture surgery include the following:
- The development of relapse - the reappearance of pathology and the development of bleeding.
- The process of extravasation, against the background of which the surrounding tissues are saturated with blood.
- Enlargement of the penis with a sharp increase in elasticity, which will subsequently contribute to the replacement of spongy tissue with connective tissue.
- Displacement of the installed stent, which will cause severe pain during intercourse and while sitting.
Prevention of pathology
In order to carry out prevention, it is necessary to monitor the risk of acquiring diseases that are sexually transmitted. In this regard, it is required to abandon casual relationships, and, in addition, use barrier methods of contraception. To avoid this unpleasant disease, it is equally important to observe the rules of personal hygiene in the process of intimate life. As part of this recommendation, regular hygiene of the genitals should be performed immediately after the completion of sexual intercourse. Only an individual towel should be used. Men should undergo preventive examinations by a urologist along with an examination for sexually transmitted diseases at least once a year.
It is extremely important to carry out timely treatment of urethritis in the event that its symptoms appear in men. Urethral stricture will then not occur. From the sidephysicians should exercise caution during endourethral procedures. In addition, men should avoid injury and other adverse factors such as hypothermia.
