Urethral stricture disease

Urethral stricture is a condition characterized by the appearance of scars in and around the urethra. This scarring of urethra narrows the tube which obstructs the normal flow of urine. The condition is more commonly found in men than women, and can result due to significant inflammation, trauma or infectious agent. The anatomical position can be anywhere in between penis and urethra. Along with its characteristic symptoms which include constrained flow, increased frequency and pain, the urethral strictures can also cause other complications such as renal problems, urinary tract infections, urinary retention and prostatitis.

What are some notable causes of Urethral Stricture?

Urethral strictures are more common in men due to longer length of urethra. For the same reason, this condition is rarely reported in females. Some of the most common causes of urethral stricture include,

• Accident and traumatic conditions which damage urethra
• Long standing and poorly managed sexually transmitted diseases
• Improper use of surgical equipment resulting in urethral scarring ad inflammation
• Infectious condition causing swelling

Common causes of urethral stricture in adults and old age people include,

• Direct impact of force or injury on the scrotum
• Removal of kidney stones
• History of catheterization
• Use of surgical tools on urinary organs

What are the clinical varieties of Urethral stricture?

On the basis of symptoms and pathophysiology, the condition can be classified into two different types:

• Posterior urethral stricture: Any significant impact of force or injury to the pelvic region such as pelvic fracture, or road traffic accident can causes a direct disruption of urethra. In this way the urine cannot be passed, and catheterization may be needed foe expulsion of urine.
• Anterior urethral stricture: The damage to anterior aspect of urethra is referred to as anterior urethral stricture. Classic causes include use of catheters and direct injury to the penis.

Symptoms of Urethral Stricture

Characteristic symptoms of urethral stricture include,

• Passage of extremely dark colored urine
• Appearance of fresh blood in the urine
• Appearance of blood in the semen
• Pain in the abdomen
• Penile swelling
• Urinary tract infections
• Pain during urination
• Lack of bladder control

Prevention of Urethral Strictures

Urethral strictures can be prevented by:

• Avoiding any direct injury to urethra or pelvic region. For example, use of scrotum guards can help in preventing the direct impact of force on the urethral region.
• Careful use of catheters, it can be achieved by application of a lubricating agent over penis and using smallest possible catheter (with extreme caution)
• Gonorrhea, a sexually transmitted disease was one of the commonest causes of this disorder previously. Although gonorrhea and other sexually transmitted infections can be controlled with the use of antibiotics, most people do not seek appropriate medical help.
• Condoms must be used during intercourse (especially in case of chance encounters). In addition, sexual contact must be avoided with an infected partner.
• If the problem does not resolve then use of antibiotics is highly recommended. Although urethral strictures are not contagious but STD’s (sexually transmitted diseases) are.

Treatment of Urethral Strictures

Depending upon the severity of disease and size of scarring and obstruction, different treatment methods can be opted

• Dilation: The urethral stricture can be enlarged with gradual stretching of urethra via ballooning devices. In this way, the urinary flow can be increased.
• Urethrotomy: The urethral stricture is cut out/ incised with the help of a sharp and sterile knife through scope or via laser technique
• Open surgery: Surgery is performed in which the stricture is removed; the bladder is then reconnected with the body. This process of reconstruction is also termed as urethroplasty.

As far as the use drugs are concerned, no specific therapy is available for reversing the condition of scarring. Fortunately, the success rate of most interventional procedures listed above is excellent. Therefore, opting treatments listed above can significantly control the condition. It is imperative to mention that poor management of urethral stricture disease can lead to serious complications such as development of urinary tract infections, kidney stones, urinary retention problem, or enlargement of bladder.

References:

1. Zelefsky, M. J., Wallner, K. E., & Ling, C. C. (2014). Urethral Stricture Disease: Etiology, Pathophysiology and its Economic Impact 17. Atlas of Urethroplasty, 17, 16.

2. Hindson, B. R., Millar, J. L., & Matheson, B. (2013). Urethral strictures following high-dose-rate brachytherapy for prostate cancer: analysis of risk factors. Brachytherapy, 12(1), 50-55.

3. Barbagli, G., Palminteri, E., & Guazzoni, G. (2014). The distal penile fasciocutaneous flap is a robust and reliable option for long-segment urethral stricture disease in any anterior urethral location. It has excellent long-term results with minimal morbidity, and can be combined with other tissue transfer techniques as necessary. Atlas of Urethroplasty, 29(2), 94.