Urethral strictures societe internationale durologie. In some cases, the urethra is reconstructed by removing the scar tissue and then suturing the ends of the urethra back together, called an urethroplasty. Retrograde urethrography rug with or without voiding cystourethrography vcug allows for identification of stricture location in the urethra, length of the stricture, and degree of lumen narrowing. This is usually due to tissue inflammation or the presence of scar tissue. Inflammation, an injury or an infection can create this scar tissue. When there is urethral stricture disease and prostatitis, the best approach is to treat the stricture. Urethral dilation can be performed in the office with local anesthesia with lidocaine jelly and is still a mainstay of therapy for stricture disease. A urethral stricture is a narrowing in any part of the urethra the tube that drains urine from the bladder. Common imaging and endoscopic tests to evaluate urethral strictures include ultrasound of the urethra, retrograde urethrogram, anterograde cystourethrogram and cystourethroscopy. Pdf urethral stricture disease in men researchgate. Imagine a narrowing or kink in a garden hose which will slow the stream of water.
The prevalence of urethral stricture disease in the uk has been estimated between 10100,000 in younger men to 100100,000 in men older than 65. Management of men with anterior urethral stricture disease is a relatively common issue faced by practicing urologists today. A number of options exist for the treatment of this disease ranging from the more simple. The stricture may be due, for example, to scar tissue or to a tumor. This is further supported by the high prevalence of primary urethral cancer in the bulbomembranous urethra, which is also the most common location of urethral strictures. Were going to take a detailed look at urethral stricture. A urethral ureethrul stricture involves scarring that narrows the tube that carries urine out of your body urethra.
Urethral stricture guideline american urological association. Urethral stricture occur predominantly in males for the male urethra is 67 times longer than the female. Transurethral surgery transyooreethruhl surjuhree surgery performed with a special instrument inserted through the urethra. Pdf most urethral strictures are either idiopathic or iatrogenic secondary to urethral instrumentation or failed surgery for hypospadias. Urethrography is a radiological investigation in which a radio opaque dye is used to opacify urethral lumen and then xray pictures are taken to explore the exact site, extent and size of urethral stricture. The main treatment options include enlarging the stricture by gradual stretching dilation. Selecting the optimal procedure for individual case of complicated pud is essential. Mr imaging and us of female urethral and periurethral disease. My father, at present aged about 81 years, has been suffering from stricture of urethra for the last 25 years or so.
Conclusion urethritis is still the most common single etiological factor in urethral stricture disease in this rural community. A literature search involving pubmed and the cochrane library was performed spanning the period between 1990 and 2008 to evaluate the evidence for certain controversial topics in urethral stricture disease management. Excepting trauma or otherwise when the urethral lumen is obliterated, the characteristic feature of a stricture is replacement of the corpus spongiosum deep to the urethral epithelium by dense. Management of urethral strictures urethral strictures. Urethral stricture disease symptoms, diagnosis, and. The testing required to fully evaluate and treat urethral strictures includes an xray of the urethra called a urethrogram and looking inside the urethra with a small scope. Establishing effective drainage of the urinary bladder can be challenging, and a thorough understanding of urethral anatomy and urologic technology is essential. Stricture formation can be due to inflammation, fibrosis or neoplasia involving the. Endoscopic treatment has lower success rates, and can be a reasonable first line treatment if the stricture is short, limited to bulbar part of urethra and is not very tight. Post urethroplasty recurrent urethral strictures are at times amenable to dviu as the first choice. Incision of urethral stricture continues to be the predominant treatment of this disease, and a recent study reveals that 82. If severe, bladder hypertrophy and trabeculation may occur. There are two types of urethral stents temporary and permanent.
Urethral stricture disease is still a prevalent problem with an estimated incidence of 0. The criterion standard for treatment of bph is the transurethral resection of the prostate turp. Although not a life threatening condition, the treatment of urethral stricture is one of the most challenging situations for the urologist and a very trou. This scarring of urethra narrows the tube which obstructs the normal flow of urine. Analysis of risk factors in the postturp urethral stricture hypothesis aims of study urethral stricture is a common complication after transurethral resection of prostate when treating bph. A urethral stricture occurs when scar tissue in or around your urethra limits or blocks the flow of urine. Panurethral strictures by definition involve the whole anterior urethra and form a complex subset of urethral stricture disease. However, urethral stricture treatment should be based on the findings obtained during a diagnostic evaluation and a detailed discussion of all treatment options, with treatment tailored to each individual patient. Pdf male urethral strictures and their management researchgate.
Panurethral strictures are relatively less common and the literature about this condition is scant. The real incidence of male urethral stricture disease remains unknown, and worldwide differences have been observed based on geography, population, and mean. Transurethral microwave thermotherapy of the prostate tumt as the population ages, a greater number of men are presenting with symptomatic benign prostatic hypertrophy bph. Treatment offered may be endoscopic minimally invasive or by open surgery. Novel surgical technique for female distal urethral stricture disease. Urethra is the tube that carries urine out of the body from the bladder to the external environment. In general, urethral strictures are divided into two main categories. The primary mode of presentation of a symptomatic stricture is with poor urinary stream. It causes reduced urine flow and more frequent urination.
Current management of urethral stricture disease ncbi. Fast imaging with steadystate precession with a small field of view. Quality and length of life, money and urethral stricture disease. Stricture refers to both the process of narrowing and the narrowed part itself. The diagnosis was made by exclusion of the inflammatory and traumatic causes. Ischaemia is a common underlying cause or predisposing factor in stricture disease but rarely referred to as such. Recently, however, there has been a trend in etiology, favoring more iatrogenic panurethral. Urethral stricture disease urethral stricture disease. Urethral stricture disease is a narrowing of the urethra caused by injury, inflammation or infection that results in scarring. Incidence, causes, and complications of urethral stricture. The prevalence of urethral stricture disease in the us is estimated between approximately 200100,000 in younger men to 600100,000 in men older than 65. Follow up was at regular intervals using uroflow assessment. Reduced volume of urine or the urine flow being weak frequent and sudden urges to urinate feeling that the bladder is still full even after urinating difficulty starting the flow of urine and stopping the stream as well burning or a sensation of pain while.
The focus of this article is anterior urethral stricture disease. Urethral stricture is an abnormal narrowing of the urethra. The condition is more commonly found in men than women, and can result due to significant inflammation. Urethral strictures arise from various causes and can result in a range of manifestations, from an asymptomatic presentation to severe discomfort secondary to urinary retention. A stricture in the urethra can cause weakening or spraying urine stream, painful urination and occasionally blood from the urethra. Symptoms there can be numerous symptoms caused by urethral stricture that can range from mild to severe. His main complains have been constant burning sensation from the bladder upto the external meatus with a feeling as if there is some obstruction on the tip of penis. Dec 14, 2010 prweb december 14, 2010 according to dr. Pdf male urethral stricture disease is prevalent and has a substantial impact on quality of life and healthcare costs. Management of panurethral strictures sciencedirect.
In general, the term urethral stricture refers to a fibrous scarring of the anterior urethra caused by collagen and fibroblast proliferation. The current thinking is if one dviu does not cure stricture the second will not so only dviu is recommended. Management of the recurrent male urethral stricture. The diagnosis of urethral stricture begins with a history and physical exam. Gre gradientecho, te echo time, tr repetition time. While this procedure is more involved and far more complex than other treatments, it is considered the gold standard of urethral stricture treatment, with the best longterm outcomes and lowest rate of reoccurrence. Female urethral stricture disease is a rare entity. Urethral stricture in men diagnosis and tests cleveland. The urethra s main job in males and females is to pass urine outside the body. We aim to explore the risk factors resulting in urethral stricture after transurethral resectiong of prostate. It can result from a multitude of aetiological factors, with iatrogenic causes, trauma and idiopathic strictures responsible for most cases in the contemporary world. Urethroscopy readily identifies a urethral stricture, but does not delineate the location and length of strictures.
The epithelium itself is usually intact, albeit abnormal 8,27 fig. The types of open surgeries for treating stricture disease vary. Urethral strictures by patti hamilton what is a urethral stricture. Dec 14, 2018 primary urethral cancer is an extremely rare lesion, with fewer than 2000 reported cases and comprising less than 1% of the total incidence of malignancies. Management of longsegment and panurethral stricture disease. Seven cases of anterior urethral stricture were studied. Artisans such as drivers and mechanics were the most commonly afflicted. There are several causes of urethral stricture, including a prior surgery, catheter placement, infection resulting from a sexually transmitted disease std, and, in men, trauma to the penis or perineum, which is the pelvic floor area behind the scrotum. Urethral stricture involves constriction of the urethra. One study found that 88% of male patients with urethral cancer had a history of stricture. Urethral stricture disease urethral strictures occur when scar tissue develops in the channel that carries urine from the bladder out through the penis the urethra. Retrograde urethrogram rug is the main diagnostic method to find anterior urethra stricture and help.
When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Urethral stricture disease is associated with varying degrees of fibrosis of the spongiosum. It starts at the opening of the bladder and traverses the entire length of the vulva or the penis. How can recurrent stricture in urethra be prevented. Although the true incidence of urethral stricture disease in men is unknown, medicare utilization. A urethral stricture is when a portion of the urethra is abnormally narrowed. Some of the other causes for urethral stricture are pelvic fractures, insertion of catheters, radiation therapy, or prostate surgery. This scar tissue may be caused by injury, infection or from unknown reasons. Longsegment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. From urethral stricture causes and urethral stricture symptoms, to urethral stricture treatments, well give you the basics of urethral stricture so that you will be prepared if it happens to you.
A urethral stricture is a scar in or around the urethra, which can restrict the flow of urine. General information about urethral stricture disease baus. The urethrogram is usually performed by a radiologist in the xray department. Ucsf department of urology urinary tract strictures. Urethra is the tube that carries urine out of the body from the bladder. The morbidity of urethral stricture disease among male medicare. For this reason, it is often difficult to treat primary urethral cancer.
Patients will often describe certain risks factors see above, and for those patients with the symptoms, described above, a thorough investigation is required to rule out urethral stricture or complications related to one. Urethral stricture disease affects many men worldwide. The late presentation of ls is in the form of full length strictures of the penile and bulbar urethra. Intestinal strictures are narrowings in the bowel which are more common in people with crohns disease than ulcerative colitis.
Urethral stricture occurs mainly in men, and the disease is a common and challenging urologic condition. Quality and length of life, money and urethral stricture. Urethral stricture scarring of corpus spongiosum and overlying urothelium. Primary urethral cancer puc is an extremely rare lesion that accounts for less than 1% of the total incidence of all malignancies. Currently urinating with catheter due to pananterior urethral stricture. Urethral stricture causes, symptoms and prevention authorstream. Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i. The bulbous urethra is probably the commonest site of narrowing and the treatment options is relatively well defined. Urethral stricture refers to any narrowing of the urethra, independent of whether it affects the flow of urine out of the bladder.
This is a pdf file of an unedited manuscript that has been. The symptoms that are highly suggestive of urethral stricture are retention of urine, involuntary urination, symptoms of bladder, symptoms of prostate, symptoms of the scrotum and testes, and penis redness, although you may still have urethral stricture without those symptoms. Immediate treatment of pud is important to prevent future complications. It is a serious sequela to many different disease processes and underlying etiologies. Management of urethral stricture disease presents constant challenge for all reconstructive urologists. The results obtained were good, with a followup of 5 to 50 months. If a urethral stricture is suspected, an imaging procedure will be needed to identify and measure it. Strictures can also be caused by pelvic fractures from major trauma. Surgical treatment of anterior urethral stricture diseases. Etiology urethral injury, disease, catheterization or surgery that results in inflammation or scar tissue. Management of distal anterior urethral strictures nature. Fortunately, there is a curative surgical treatment. However, it is a particularly difficult surgical challenge for the reconstructive urologist. During the course of a turp, it has been estimated that the instrument moves up and down within the urethra some 800 times 22.
Are there any complications and risks associated with it. When the blockage is relieved, this will decrease the pressure within the prostatic urethra during urination and may prevent recurrence of prostatitis. The urethroplasty, also known as open surgery, is the surgical removal of the stricture with the reconstruction of the urethra. A common cause of urethral stricture in boys is trauma from straddle injury. Hypospadias repair is the most common surgery to cause urethral stricture disease, but prior instrumentation can also cause stricture disease. A literature search involving pubmed and the cochrane library was performed spanning the period between 1990 and 2008 to evaluate the evidence for certain controversial topics in urethral stricture disease management, results and conclusions. A straddle injury is caused due to being hit around the scrotum or falling directly on bicycle bar. Urethral stricture disease is generally defined as stenoses that are typically long, involving broad areas of varying spongiofibrosis, and result from inflammation andor infection, rather than trauma. No formal studies of urethral stricture disease incidence have been published. Sonourethrography su is a useful adjunct to allow for threedimensional assessment of stricture length and location, and can be a useful. A colon stricture is the narrowing of the large intestine. Our method of choice for the treatment of penile urethral strictures due to ls is the kulkarni panurethral onesided dorsal onlay technique. Chronic inflammation and scars from inflammatory bowel disease, such as crohn disease.
This is an xray procedure that uses a contrast agent that is squirted into the opening of the penis. The urethra is the tube that carries urine from the bladder out the tip of the penis, and the narrowing of the urethra results in difficulty with urination, and can lead to urine infections, prostatitis, bladder damage, and even kidney failure if left untreated. It has a predilection for men and african americans. An esophageal stricture refers to the abnormal narrowing of the esophageal lumen. Current management of urethral stricture disease smith tg.
A stricture slows or prevents waste from passing through your large intestine. Urethral stricture what you need to know the award. Obstruction of the urethral wall urethral stricture. Anterior urethral strictures, which can be the result of congenital. The urethra is the tubelike structure that carries urine from the bladder and out of the body.
Considerations are made about embryogenic, diagnostic, clinical picture and treatment. The choice of technique and the surgical approach are discussed along with the potential pros and cons of the use of a graft vs a flap. Most cases of urethral stricture disease in the anterior urethra are consequent on an ischemic spongiofibrosis. This thin tube also has an important role in ejaculation for men. Although not a part of the excretory tract, the prostate lies close to the bladder neck, and in older men it is an important cause of obstruction. In three cases the stricture was located in the bulbar and in four cases in the penile urethra. Symptoms vary but may include a slow urine stream with prolonged urine time, discomfort with urination, blood. Urethral stricture is chronic fibrosis and narrowing of the urethral lumen caused by acute injury, inflammatory conditions, and iatrogenic interventions including. Male urethral stricture american urological association. What are the complications associated with panurethral stricture. Urethral stricture may be caused by swelling or scar tissue from surgery.
Urethral stricture disease, the urology practice 2019, doi. An abnormal narrowing of a body passage, especially a tube or a canal. Management of panurethral stricture disease in india. Panurethral stricture may be repaired surgically using 1stage or multistage techniques according to disease etiology and extension, and based on surgeon background and preference.
National trends in the management of urethral stricture disease. If dilation or urethrotomy fails and the stricture returns, urethral reconstruction may be needed to obtain a durable result in terms of opening the urethra. Treatment options for urethral stricture disease are varied and selection depends upon the length, location and degree of scar tissue associated with the stricture. Anterior urethral stricture disease is a fairly common problem encountered by urologists figure 1. Treating urethral stricture medication can help manage urethral strictures, but the only real treatment for curing severe cases is surgery. The most common etiologies are traumatic injury, iatrogenic injury, and inflammatory disease resulting in periurethral fibrosis. Urethral stricturetreatmentexerciseprognosiscauses. In many cases, open urethral reconstruction is the best approach for the treatment of urethral stricture disease. April 2020 british association of urological surgeons baus limited what is a urethral stricture. Lichen sclerosus remains a primary etiology for panurethral stricture disease, particularly in the asian subcontinent.
Colon strictures can become lifethreatening if they are not treated. The urethras main job in males and females is to pass urine outside the body. Urethral stricture is the term applied to abnormal narrowing of the anterior urethra, whereas the american urologic association prefers the term stenosis for narrowing of the posterior urethra, which lacks spongiosum. The urethra is a tube that carries urine from your bladder out of your body. Urethral stricture disease negatively impacts quality of life and leads to significant urologic pathology including lower urinary tract symptoms, recurrent urinary tract infections, and potentially more severe sequelae such as detrusor dysfunction, renal failure, urethral carcinoma, and fourniers gangrene.