Urethral Stricture Ds

Urethral stricture is the abnormal narrowing of the urethra ( tube that releases urine from the body).

Causes, incidence, and risk factors

Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.

Risk Factors include history of sexually transmitted disease (STD) & repeated episodes of urethritis. There is also an increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra ( catheter or cystoscope) increases the chance of developing urethral strictures.

Urethral Stricture Symptoms

• Dysuria (painful urination) .
• Difficulty in urinating .
• Urine stream (may develop suddenly or gradually) .
• Spraying of urine stream .
• Decreased urinary output .
• Increased urinary frequency or urgency .
• Incontinence .
• Lower abdominal pain .
• Bloody or dark urine .
• Discharge from urethra .
• Swelling of penis, testes, scrotum .
• Urinary retention .
• Recurrent infections of urinary tract.

Investigations of Urethral Stricture

Include:

• Urinary flow rate
• Post-void residual (PVR) measurement .
• Urinalysis .
• Urine culture .
• Tests for Chlamydia and Gonorrhea .
• Retrograde urethrogram to confirm diagnosis .
• Urethroscopy .

Treatment

• Acute problems such as urinary retention and infection.
• Necessitates placement of a suprapubic catheter, which allows the bladder to drain urine through the abdomen.
• There are no drug regimes currently available for urethral strictures.
• Surgical options vary depending on the location and length of the stricture.

• Visual internal urethrotomy(DVIU) : may be all that is needed for small stricture. A urethral catheter is left in place after the procedure. Holmium Laser assisted DVIU is the latest addition.


• Urethral Reconstruction : Urethral reconstruction is performed by anastomotic and substitution urethroplasty. For example, buccal mucosal graft urethroplasties (single-stage or staged) are performed for traumatic or other acquired stricture disease and hypospadias



Reconstructive Urology

Reconstructive urology differs from regular urology as it usually involves open surgery and requires more general and plastic surgery skills.

The principle areas of surgical activity in reconstructive urology at AG Stone are:

• Dealing with Ureteric Defects Occurring due to Any Cause : These are usually dealt with by psoas hitch, Boari flap or transureteroureterostomy. Occasionally, ureteroureterostomy or ureteric replacement with ileum are also performed for this purpose.


• Bladder Augmentation and Substitution : Bladder augmentation and substitution is performed by continent urinary diversion for neurological diseases, malignant diseases or tuberculosis. At times, it is also performed by intestinal conduit diversion.


• Other Surgeries : In addition, vesico-vaginal and uretero-vaginal fistula repairs, scrotal and penile reconstructions are also carried out.