Urethral stricture treatment
- Published: 21 October 2018
The narrowing of the urethra occurs due to injury, inflammation or neoplastic processes, it is also can be congenital. Without the necessary treatment, the clearance of the urethra can close completely, up to an acute urinary retention.
There are only surgical methods to eliminate stricture, the method is chosen according with the patient's age, localization of the narrowing, its length and the cause.
Endoscopic dissection with a laser or a cold knife is used during the primary treatment
It is possible if there were no history for the urethra surgery. Narrowing is cut with a laser beam or endoscopic scalpel (cold knife). Instrument leads through the urethra under a spinal anesthesia. Hospitalization takes 2-3 days. During this time, urine is removed with a urethral catheter.
Disadvantages: depending on the severity and length of the narrowing, the probability of relapse in 30 to 70%.
Buccal mucosa urethroplasty is the operation of choice during relapse
It is the gold standard of treatment for penile urethra. The plot is cut out and replaced with a “patch” of biomaterial. The skin of the penis, the vaginal membrane of the testicle, the walls of blood vessels can be used. However the buccal mucosa, which is histologically similar to the urethral tissue, is the best suited. Cheek mucosa is used to replace any strictures, except the cases when the urethra has come off as a result of a fracture of the pelvic bones.
Replacement plastic is performed by an open method under deep anesthesia, hospitalization takes up to 10 days. Despite the complexity, it is considered an ideal option of treatment, because of buccal plastic surgery can be performed at any age patient. It has the lowest percentage of relapses among operations on the urethra.
Disadvantages: extremely rarely – transplantation rejection, contracture of the cheek (limitation of the amplitude of movements in the place of transplant intake).
Bougienage is possible in only case - narrowing of the anterior urethra.
In case of the stricture is less than two centimeters, and there were no history for the urethra surgery. Bougie are metal or plastic rods. Each time increasing the thickness, it is introduced into the place of constriction. The manipulation takes a few minutes; it is performed on an outpatient basis under local anesthesia.
Disadvantages: depending on the severity and length of the narrowing, the probability of relapse in 30 to 70%. In some cases, the stricture becomes coarser and longer.
Anastomotic urethroplasty due to rupture of the urethra.
The surgery is performed in the case when between the non-damaged ends of the urethra is no more than 3 cm. The scar tissue is removed; the urethra is sutured. The operation with open approach is under deep anesthesia.It takes 2 - 3.5 hours. Hospitalization is up to 10 days.
Disadvantages: in rare cases with extended strictures shortening or curvature of the penis and reduction of erectile function are possible.
In most cases, the urethral stricture is manifested with urinary disorders, such as weakening of the jet, uneven flow, pain, the need to often go to the toilet, etc.
Range of examinations are performed to diagnose and determine the severity of the disease a.
Uroflowmetry determines the rate of urination, a decrease which indicates as a possible problem.
X-ray control with the introduction of a contrast agent (urethrography) shows the location of the narrowing.
If the radiation methods did not show a clear localization and length of the urethral stricture, perform additional endoscopic examination - urethrocystoscopy.
The Department of Urology at Sechenov University patented a method for diagnosing a narrowing of the urethra. The standard set of studies in our clinic is supplemented by its own method, which is called micronization ultrasonic cystourethroscopy. The development and length of the structure is assessed using a special ultrasonic sensor due to urination, which helps to perform the operation with the best effect.