Urethral strictures can cause numerous signs and symptoms that range from mild to severe. Urethral problems may cause pain or difficulty passing urine. The goal of urethral dilation is to stretch the scar without tearing the mucosa allowing a gradual enlargement in the urethral lumen. Predictors of recurrence of urethral stricture disease. Open urethroplasty is the gold standard treatment involving stricture excision with reanastomosis. Codifying anterior urethral strictures with urethral. Jurnal urethral disease urology genitourinary system. Unfortunately, symptoms are rarely experienced before the calibre of the urethra has been reduced to about one. Jan 22, 2020 a urethral stricture is a narrowing of the urethra, the tube through which urine leaves the bladder and exits the body. This thin tube also has an important role in ejaculation for men. Male urethral reconstruction and the management of. Incision of urethral stricture continues to be the predominant treatment of this disease, and a recent study reveals that 82.
When a phalloplasty urethral stricture occurs, the distribution by location is 15% in the urethral meatus usually as the result of partial distal penile flap loss, 24% in the pendulous urethra, 41% in the anastomotic urethra, % in the fixed urethra, and 8% are multifocal. Clinicians should include urethral stricture in the differential diagnosis of men. Urethral strictures for men university of utah health. To conduct a study of epidemiological, diagnostic and therapeutic aspects of urethral strictures at yalgado ouedraogo university teaching hospital. In rare cases a urethral stricture can be formed due to presence of a tumor near the urethra. Jurnal urethral disease free download as powerpoint presentation. Jan 11, 2019 according to a study, a straddle injury can cause urethral stricture. The strictures were mostly in the penile part of the urethra and could be treated with regular dilation, internal urethrotomy or metal incision. Urethral stricturetreatmentexerciseprognosiscausessymptoms. Considerations are made about embryogenic, diagnostic, clinical picture and treatment. Dec 12, 2018 urethral stricture is much more common in males than in females.
Study inclusion criteria were 1 clinical diagnosis of stricture, 2 stricture seen on cystoscopy, 3 urethral obstruction on videourodynamics according to the blaivasgroutz nomogram andor 4 urethral caliber less than 17fr. As eight patients had a urethral stricture on initial cystoscopy, and those with strictures are clinically indistinguishable symptomatically from those without, we feel that uroflow and selective cystoscopy are important tools for the workup of severe and persistent cases of urethrorrhagia. Some of the other causes for urethral stricture are pelvic fractures, insertion of catheters, radiation therapy, or prostate surgery. Male urethral stricture disease continues to be a common and often challenging urological condition. 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 diagnosis was made by exclusion of the inflammatory and traumatic causes. Wisenbaugh u n i v e r s i t yo fc a l i f o r n i a,i r v i n e,3 3 3c i t yb o u l e v a r dw e s t,s u i t e1 2 4 0,o r a n g e,c a9 2. Pdf male urethral strictures and their management researchgate. A urethral stricture is when a portion of the urethra is abnormally narrowed. This is usually due to tissue inflammation or the presence of scar tissue. Surgery is the only treatment for people with uncontrolled symptoms of urethral narrowing.
These can be managed with antibiotics and treatment of the urethral stricture. Urethral stents where a biocompatible hollow tube is placed on the inside of the stricture to allow for free passage of urine. Urethral stricturetreatmentexerciseprognosiscauses. Urethral stricture guideline american urological association. 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. Urotronic offers new hope for men suffering from urethral strictures u. American urological association issues guideline for male. Urethral strictures have multiple causes including prior urinary tract infection, catheter placement, injury to the urethra, pelvic radiation. It is characterized by decreased urinary stream and often other obstructive voiding symptoms. Management of distal anterior urethral strictures nature. Pdf male urethral stricture disease is prevalent and has a substantial impact on quality of life and healthcare costs. Recent advances in surgical techniques have expanded the possible options available for the functional repair of urethral stricture disease.
Balloon catheter dilatation of urethral strictures. Excision and primary anastomosis reconstruction for. Seven cases of anterior urethral stricture were studied. Urethral stricture stenosis is a narrowing of the urethral lumen. Hallmark symptoms are frequency and urgency, and may also be dysuria, hesitancy, slow stream, incontinence, and recurrent urinary tract infections.
April 2020 british association of urological surgeons baus limited what is a urethral stricture. The association of urethrorrhagia and urethral stricture. Urethral stricture treatment at home best at home nursing. The most common etiologies are traumatic injury, iatrogenic injury, and inflammatory disease resulting in periurethral fibrosis. Dec 23, 2016 urethral stricture stenosis is a narrowing of the urethral lumen. The declined erecti le function was more possibly occurred in patient with recurrence of urethral stricture and surgical complication. Incidence, causes, and complications of urethral stricture. Patients should be counseled appropriately on the potential for late recurrence of stricture disease after urethroplasty. Martins, 2 vladimirkojovic, 1 anddmitrykurbatov 3 school of medicine, university of belgrade, belgrade, serbia university of lisbon, lisbon, portugal endocrinology research center, andrology and urology department, moscow, russia. The prevalence is estimated to be 229627 per 100,000 males. The urologists offer a comprehensive form of cure for urethral stricture.
Female urethral stricture fus represents a rare condition, yet one that can cause significant, bothersome lower urinary tract symptoms luts. Urinary backup can also cause complicated urinary tract infections. A urethral stricture is an abnormal narrowing of the urethra resulting from fibrosis in the surrounding corpus spongiosum. A urethral stricture is a narrowing of the urethra, the tube through which urine leaves the bladder and exits the body. 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. Broadly defined, urethral strictures are narrowing of the urethral lumen that is. Jan 02, 2017 a clinical framework to guide providers in the diagnosis and treatment of male urethral stricture has been developed by authors on behalf of american urological association education and research. Pdf urethral stricture disease in men researchgate. Posterior urethral strictures joel gelman and eric s. Urethritis inflammation of the urethra, sometimes caused by infection. The diagnosis of urethral stricture begins with a history and physical exam.
Some of the signs of a urethral stricture include weak urine flow or reduction in thevolumeofurine,urinaryurgency,painduringurination, incontinence, pain in the pelvic or lower abdominal area, urethral discharge, penile swelling, the presence of blood in. Urethral dilation and internal urethrotomy are the most commonly performed procedures but. Management of urethral stricture in women request pdf. Urethral stricture disease is defined as a narrowing of the urethra between its origination at the bladder and its outlet at the penis tip. To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Oct 17, 2008 female urethral stricture disease is a rare entity.
Urethral stricture disease can develop throughout the entire length of the male urethra and can be caused by a large variety of etiologies. A urethral stricture can also cause inflammation of the prostate. Bladder syndrome, ureteral obstruction, pediatric urology, interstitial cystitis and urethral stricture. Reconstructive urology excision and primary anastomosis reconstruction for traumatic strictures of the pendulous urethra nabeel a. We have seen patients referred for strictures initially limited to the bulbar urethra who then developed narrow caliber fossa strictures aer undergoing painful urethral imaging where the technique included balloon in ation within the fossa. Management of urethral stricturesstenosis is complex and requires careful evaluation. Male urethral stricture may be due to congenital abnormality or acquired diseases. Management of longsegment and panurethral stricture disease.
Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious. Pdf advances in urethral stricture management semantic. Urethral stricture complicating transurethral prostatic. Urethral stricture symptoms and causes mayo clinic. The incidence of urethral stricture was 9 per cent among 336 patients after transurethral prostatic resection for benign hyperplasia. The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at. Urethral stricture or stenosis is frequently managed with either serial urethral dilation, such as filiform and followers or urethral sounds, or radial dilation, such as balloon dilation. Urethral strictures and their surgical treatment d. It was about a retrospective and descriptive study conducted in the urology division of yalgado ouedraogo hospital from october 1st 2009 to september 30th 2014. Female bladder outlet obstruction is a difficult entity to define. Urethral stricture is an abnormal narrowing of the urethra, the tube that carries urine out of the body from the bladder. However, it is a particularly difficult surgical challenge for the reconstructive urologist. These conditions greatly impact the health and quality of life of patients.
Treating urethral stricture medication can help manage urethral strictures, but the only real treatment for curing severe cases is surgery. Management of men with anterior urethral stricture disease is a relatively common issue faced by practicing urologists today. The urethra is the urinary channel that starts in the bladder, travels through the prostate, and out the penis. This condition may be caused by inflammation or scar tissue from surgery, disease or injury. Cutting the stricture with a endoscopic equipment urethrotomy and surgical repair of the stricture with reconnection and reconstruction called urethroplasty. Symptoms include painful urination, urinary retention, and pelvic pain. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. In our experience, nearly all urethral strictures will be found at.
In three cases the stricture was located in the bulbar and in four cases in the penile urethra. 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. The male urethra is a tubular structure about 18 cm in length, and it may present an occlusion or reduction of his caliber that is called urethral stricture. Urethral stricture stricture lichen sclerosus pelvic fracture urethral injury bladder outflow obstruction urethroplasty buccal mucosa graft. Food and drug administration fda approves clinical trial of drugcoated balloon catheter truckee, ca doctors are beginning a clinical study of a new medical solution that could dramatically change the way urethral strictures are treated today for millions. A urethral stricture, or narrowing of the urethra, may cause decreased urine output. This proved that successfully cure the urethral stricture might the main contribution of the sexual function improvement, and was the reason of 23.
The clinical guideline on male urethral stricture provides a clinical framework for the diagnosis of urethral stricture and includes discussion of diagnosis and initial management, urethroplasty, reconstruction, contracture, stenosis, special circumstances, and postoperative followup care. Morphologic assessment of male urethral stricture and. Current management of urethral stricture disease ncbi. Urethral strictures and their surgical treatment andrich. Risk of urethral stricture recurrence increases over time. In male urethral stricture the corpus spongiosum of the urethra scars, contracting the lumen and causing obstructive voiding symptoms, urinary retention, and utis. Study inclusion criteria were 1 clinical diagnosis of stricture, 2 stricture seen on cystoscopy, 3 urethral obstruction on videourodynamics according to the blaivasgroutz nomogram andor 4 urethral. Guideline statements were developed to aid the clinician in optimal evaluation, treatment, and followup of patients presenting with urethral strictures. You may also have bleeding or discharge from the urethra. Urethral stricture disease is associated with varying degrees of fibrosis of the spongiosum. Male urethral stricture american urological association. Diagnosing urethral stricture diagnostic tests such as urinalysis ua, urine culture and urethral culture for sexually transmitted diseases like gonorrhea, chlamydia can be ordered to determine if you have urethral strictures.
Pdf anterior urethral strictures affect the male urethra between the tip of the penis and the apex of the prostate. Mundy institute of urology and nephrology, london, uk introduction in most instances a urethral stricture is a narrowing of the calibre of the urethra caused by the presence of a scar consequent on infection or injury. This guideline provides evidence guidance to clinicians and patients regarding how to recognize symptoms and signs of a urethral stricture stenosis, carry out appropriate testing to determine the location and severity of the stricture. Management of urethral stricture in women sciencedirect. The management of urethral stricture in women includes urethral dilatation, urethrotomy, clean isc and substitution urethroplasty 10,15. Anterior urethral strictures, which can be the result of congenital. Pdf management of anterior urethral strictures researchgate. Urethral stricture can cause numerous symptoms, ranging from mild to severe. Urethral stricture a narrowing of the opening of the urethra.
The dilatation was performed on an outpatient basis in conjunction with suprapubic voiding cystourethrography and under fluoroscopic control. Patients with urethral stricture disease commonly have difficulty urinating or a weak stream. Seven patients with urethral strictures due to different causes were treated by balloon catheter dilatation. A stricture is a dense scar that occurs somewhere along the urethra. This narrowing often causes difficulty with passing urine, including straining and pain in the urethra. Failed hypospadias surgery may be anything from meatal stenosis to a full. It may also be caused by pressure from a growing tumor near the urethra, although. Learn how the common disorders, urethritis and urethral stricture, affect each gender. The urethra s main job in males and females is to pass urine outside the body.
Strictures can occur anytime in life and cause obstruction of the. All the patients, included in this study, had a urethral. The treatment options for urethral stricture vary in their success rates. Your urethra is surrounded by the prostate, just under the bladder. The first reported cases using umbilical vein as urethral graft in urethral stricture yielded good results 85%, alnaieb in 1985. Management of urethral strictures stenosis is complex and requires careful evaluation.
International journal of contemporary medical research. We retrospectively identified female urethral strictures from 1998 to 2010. Although minimally invasive techniques have been added to the surgical armamentarium and are extremely useful in certain clinical situations, open urethroplasty remains a secondline treatment of choice in many patients. The results obtained were good, with a followup of 5 to 50 months. The management of urethral stricture has evolved over the past few decades, however, the three most commonly used procedures, i. Historically, urethral dilation has been a preferred treatment choice for these patients. Surgeons should offer urethroplasty to patients with penile urethral strictures, given the expected high. International journal of scientific study june 2016 vol 4 issue 3. Discussion urethral stricture is a rare diagnosis in a woman, with a variable reported prevalence of 2.
Imaging and endoscopic studies are sometimes necessary to confirm the diagnosis and identify the cause of urethral. A straddle injury is caused due to being hit around the scrotum or falling directly on bicycle bar. Clinical profile, management and treatment outcome in urethral. Urethral disorders may cause pain or your ability to urinate.
Urethral stricture involves constriction of the urethra. The etiology varies according to age and geographic location, lichen sclerosus being. Current trends in urethral stricture management asian journal of. Bacteriuria or indwelling catheter preoperatively did not seem to predispose to stricture formation.
Doctors diagnose urethral problems using different tests. You will be able to get options for urethral stricture care at home, urethral stricture home treatment options and much more. Apr 22, 2015 urethroplasty for urethral stricture is the most durable treatment modality, regardless of surgical approach. Urethral stricture diseasefinding, stricture urethral, stenosis urethra expand narrowing of any part of the urethra. Urethral stricture after phalloplasty jun translational. They also provide urethral stricture home treatment options for the patients. For reasons that are not clear the stricture, if there is an anterior urethral stricture, normally stops abruptly at the level of the bulbar urethra. Urotronic offers new hope for men suffering from urethral. Male urethral strictures in ouagadougou burkina faso.