Urethral strictures

Any part of the urethra can be affected. Patients with this condition experience difficulty urinating and incomplete bladder emptying.

Urethral strictures present a significant functional, psychological, social, and sexual burden for all affected individuals.

Causes of urethral strictures include:

• Trauma: Falls, pelvic fractures, etc.

• Infections: Gonococcal and chlamydial infections

• Skin conditions: Lichen sclerosus

• Congenital penile anomalies: Hypospadias, epispadias

• Iatrogenic causes: Catheterization, endoscopic procedures

Urethral strictures of unknown origin are referred to as idiopathic.

Therapy

Treatment methods for urethral stricture include dilation, endoscopic incisions (urethrotomy), and surgical reconstruction (urethroplasty).

• Dilation procedures:
  In this approach, the stricture is stretched using a progressively enlarging metallic dilator. Dilation contributes little to actual healing and therefore must be performed regularly. Pain, bleeding, infections, and the creation of an “incorrect flow channel” are among the main issues associated with this method
• Urethrotomy procedures:
  This refers to the incision of a narrowed segment of the urethra using a blade or a laser. The procedure is performed endoscopically with a cystoscopic camera. This method is only effective for very short urethral strictures. Like dilation, urethrotomy may lead to excessive injury to the urethral tissue and a progressively worsening stricture.
• Urethroplasty:
  Open surgical reconstruction of the urethra offers a definitive treatment for urethral stricture. A variety of techniques are used for open reconstruction. In simple cases, the narrowed segment can be excised and the two healthy ends of the urethra sutured together. In more complex strictures, one-stage or two-stage surgeries may be necessary. The type of reconstruction depends on the stricture’s characteristics (location, length, severity). Extensive narrowed segments of the urethra can, for example, be replaced using a graft from the buccal (oral) mucosa.

Symptoms

In general, the disease presents with the following symptoms:

• Difficulty emptying the bladder

• Painful urination

• Weak urine stream

• Uncontrolled spraying of the urine stream

• Post-void dribbling

• Urinary incontinence

• Recurrent urinary tract infections

• Reduced ejaculatory force

In some cases, the symptoms mentioned above may also be absent.