A urethral stricture or narrowing of the urethra is a narrowing of the urethra (urethra) that can be congenital or acquired and is usually treated with surgery. True urethral strictures mainly affect men.
What is a urethral stricture?
A congenital or acquired narrowing of the urethra is called a urethral stricture. Here, urethral strictures due to scarring constrictions are to be differentiated from stenoses (narrow points) resulting from benign prostatic hyperplasia (enlarged prostate).
Strictures are most commonly located in the prostatic, membranous, bulbar, or penile urethra, as well as in the navicular fossa. Due to the stenosis of the urethra, complete emptying of the bladder is only possible to a limited extent. This leads to an increased susceptibility to urinary tract infections, which, if the course is severe, can cause urine to back up in the kidneys and thus damage the kidneys.
A urethral stricture is symptomatic of a weakened urinary stream, which may be watering-can-like, twisted, or divided, and a “drip” after micturition (urination). Pain during micturition, in the penis or vagina and in the perineum area are also characteristic of urethral strictures.
Causes
In the case of urethral strictures, a basic distinction can be made between acquired and congenital narrowing. Congenital stenoses include malformations in the area of the external genitalia, such as hypospadias, in which the urethra is not protected by the erectile tissue.
Acquired urethral strictures are mainly caused by injuries resulting from accidents (straddle trauma, pelvic fractures ) or manipulations or surgical interventions on the urethra. In particular, endoscopic interventions via the urethra (narrowing of the anastomosis after radical surgery on the prostate, cytoscopy) and long-term bladder catheters are risk factors for urethral narrowing.
In addition, bacterial urethral infections (urethritis, gonorrhoea ), pathological connective tissue changes (balanitis xerotica obliterans, lichen sclerosus) and tumors in the urethra and surrounding structures can cause urethral strictures.
Symptoms, Ailments & Signs
A urethral stricture prevents the bladder from emptying completely. Although there is a constant urge to urinate, the stream of urine is very weak. Sometimes the beam also splits or twists. Dribbling after urination is common. The backlogged urine often causes pain when urinating.
In addition, residual urine remains in the bladder due to the incomplete emptying of the bladder. This increases the risk of urinary tract infections. As a result, a bladder infection often develops, which increases the pain and burning sensation when urinating and at the same time leads to the urge to urinate at night. Sometimes the urine is red in color.
Chronic overstretching of the bladder also damages the bladder muscles. In severe forms of a urethral stricture, complete urinary retention can also occur. The bladder fills up and can no longer be emptied. There is only an involuntary dripping, which is caused by a so-called overflow. The overfull bladder causes severe and unbearable pain.
This is a medical emergency that requires immediate attention. Long-term retention of urine can lead to kidney failure and in men prostate inflammation or inflammation of the epididymis can also develop. A serious complication is the expansion of a urinary tract infection into life-threatening urosepsis ( blood poisoning ), which often manifests itself in states of confusion, fever and finally even circulatory shock.
Diagnosis & History
A urethral stricture is diagnosed based on the characteristic symptoms in the context of the medical history. The diagnosis is confirmed by measuring the flow and pressure of the urine during micturition. Microscopic hematuria (blood in the urine) that can be detected microscopically or with the help of the Sangur test also indicates a urethral stricture.
Possible residual urine after micturition, changes in the bladder, the urethra and the kidneys as well as the thickness of the bladder wall can also be determined sonographically. The stricture can be localized and its extent determined in the context of an X-ray with contrast medium (retrograde urethrography). Any uncertainties can then be eliminated by an endoscopy of the urethra (urethroscopy).
In general, a urethral stricture has a good prognosis. In order to avoid long-term complications such as kidney damage or complete urinary retention, the narrowing should be diagnosed and treated early.
Complications
In most cases, urethral stricture occurs almost exclusively in men. The narrowing of the urethra can lead to various symptoms. The urine stream is weakened by the disease and urination is therefore only possible to a limited extent, so that the person concerned usually has to go to the toilet more often.
It is not uncommon for the urethral stricture to lead to a bladder infection. This is associated with severe and stabbing pain and severely restricts the patient’s quality of life. There is also pain and other discomfort when urinating. This is usually associated with a strong burning sensation. The pain when urinating also causes psychological problems and irritability in most patients.
In doing so, less liquid is intentionally accepted in order to avoid this pain. This can lead to dehydration. Treatment of urethral stricture is surgical and does not cause any particular discomfort or complications. After the procedure, there are also no complaints and the pain subsides. A possible tumor can also be removed without complications. Life expectancy is not affected or reduced by the urethral stricture.
When should you go to the doctor?
A urethral stricture does not heal itself, so the disease must be treated by a doctor in any case. It can only be combated by surgery. Since the urethral stricture is usually congenital, the symptoms appear at a very young age.
Those affected suffer from a very weak stream of urine. Urine continues to remain in the bladder, so that those affected have to go to the toilet relatively often. If you have these symptoms, you should be examined. Furthermore, frequent inflammation of the bladder also indicates a urethral stricture. These are accompanied by pain or a burning sensation when urinating.
If a urethral stricture is suspected, a urologist should be consulted. The doctor can usually carry out the treatment without causing any particular complications. This completely alleviates the symptoms. Since men in particular are very often affected by this disease, they should consult a doctor if the symptoms appear.
Treatment & Therapy
As a rule, a urethral stricture is treated surgically. In principle, two surgical procedures are available, the choice of which depends on the type and extent of the stenosis and the general state of health of the person concerned.
In the so-called urethrotomy (urethral slit), a urethrotome is inserted into the urethra either blindly (urethrotomy according to Otis) or under sight (urethrotomy according to Sachse) and a slit is made in the area of the stricture. To avoid complications (particularly in the case of a Sachse urethrotomy), a urinary catheter is then placed, which remains in place for several days.
To reduce the risk of recurrence, a gel containing cortisone can be injected into the affected urethra. If the surgical method does not lead to the desired success, if recurrences occur repeatedly or if there are long strictures, an oral mucosa plastic surgery is usually indicated. As part of this oral mucosa plastic surgery, the urethra is opened over the constriction and a piece of oral mucosa (from the lower lip or cheek) of the appropriate size and length is sewn in.
A bladder catheter is then placed to splint and keep the urethra open for about eight days, and an abdominal wall catheter to empty the bladder. If a problem-free and complete emptying of the bladder can be demonstrated in the course of a urethrography, the abdominal wall catheter is removed (after about three weeks).
In the case of strictures up to two centimeters in length, the narrowed section can be surgically removed and the ends of the urethra sutured. If the narrowing is due to a tumor, the therapeutic measures for the urethral stricture depend on the tumor treatment.
Outlook & Forecast
The prospect of a cure depends heavily on the time of diagnosis. Basically, the earlier a urethral structure is treated, the better the outcome. In addition, the degree of narrowing also plays a role in the chances of success. The lower it is, the more likely it is that you can live a life free of symptoms. Statistically, bulbar faucet stricture has the best prognosis, with a 50 percent healing rate.
It seems problematic that the narrowing occurs again in many cases. Even then, patients and doctors must act quickly. However, with repeated interventions after the initial treatment, the chance of a cure decreases. Quality of life suffers in the long run. The kidneys are attacked by the urinary retention. The complete loss of kidney function can set in years later. Sometimes re-interventions have a negative effect on everyday life. People urinate in significantly reduced amounts and frequently complain about burning and inflammation.
Overall, a differentiated picture emerges: if the first intervention takes place early, patients usually remain symptom-free for the rest of their lives. However, others affected need to be treated again. The chances of a complete cure can be rated as mixed.
Prevention
A urethral stricture can be prevented by avoiding triggering factors. For example, infections of the urethra should be treated early and consistently or prevented by suitable protective measures (gonorrhea) in order to avoid strictures of the urethra.
Aftercare
In the case of a urethral stricture, the follow-up measures are severely limited in most cases. The person concerned is primarily dependent on a quick diagnosis with subsequent treatment so that there are no complications or other symptoms. The earlier the disease is recognized and treated, the better the further course is, as a rule.
Since the urethral stricture cannot heal itself, the patient should consult a doctor as soon as the first symptoms and symptoms of the urethral stricture appear. In most cases, this disease is treated with a minor surgical procedure. The person concerned should definitely rest after such an operation and protect his body.
Efforts or stressful activities should also be avoided in order not to unnecessarily burden the body. The disease does not reduce the life expectancy of the affected person if it is recognized and treated in time. Since the urethral stricture can also lead to psychological upsets or depression, the support and care of one’s own family or friends is very important. However, a doctor should always be consulted in the case of serious mental disorders.
You can do that yourself
If a urethral stricture has been diagnosed, those affected can take some measures themselves to relieve the symptoms and promote the healing process.
First of all, any side effects such as bladder infections or urinary retention must be cured. This applies to bed warmth and wearing sufficiently warm clothing. A healthy and balanced diet can help with recovery. In the case of severe symptoms, the individual symptoms should be clarified by a doctor and, if necessary, treated with medication.
Rest and bed rest apply after an operation on the urethra. Those affected should take sick leave for at least a week and refrain from strenuous physical activity during this time. In addition, the surgical wound must be cared for according to the doctor’s instructions so that no wound healing disorders occur or scars remain.
If symptoms reoccur after the treatment, it is best to talk to the responsible doctor. Reoperation may be needed, or the urethral stricture may have a serious cause that has not yet been identified. Finally, it is important to avoid another urethral stricture. This is achieved by treating infections of the urethra early and consistently. Ideally, infections are prevented by taking appropriate protective measures.
