Stricture Urethra one of the oldest diseases of the mankind has evolved in treatment in the last 5 decades. The treatment has evolved from Optical urethrotomy to Reconstructive procedures such as Urethroplasty. The types of strictures are Anterior Urethral strictures and Posterior Urethral Strictures
The human Urethra or the conduit of urine from the bladder to outside is divided into anterior or the pendulous urethra the part that includes and not limited to the part in male penis and the posterior urethra which joins immediately to the bladder.
The anterior Urethral diseases include the stricture of urethra which means narrowing of the urinary pipe due to various diseases such as infection and Lichen sclerosus a skin disorder, also responsible is catheterization of the urethra or any past surgery, particularly surgery for the prostate.
The narrowing can vary from the meatus to fossa navicularis to the junction of the posterior urethra and the Bladder mucosa. The narrowing will result in diminution of the urinary stream and increased need to force out urine using abdominal muscles. This may also be associated with leakage of urine and rarely backpressure changes in the ureter and kidneys, sometimes both sides. This may precipitate Kidney failure or Acute Kidney Injury.
Also what may happen is the complete cessation of urine passage and Retention of urine which is a Urological Emergency.
The treatment involves evaluation using Retrograde Urethrography which is an X Ray study and Uroflowmetry and Endoscopic assessment of the urinary pipe or the urethra.
The treatment depends upon the location, size and the severity of the obliteration.
Most commonly performed treatment is endoscopic dilatation or urethrotomy of the urethral stricture which is later followed by secondary or delayed healing of the scar and dilatation of the narrowed segment.
This form of treatment is short, scar less and needs minimal admission and short duration of catheter drainage for a couple of days
This is indicated for short ( 2 cm) urethral strictures in Bulbar Urethra. Penile urethra strictures do not fare well with this form of treatment.
Other forms of treatment include urethroplasty which varies from a short segment Bulbar Urethra stricture needing small Buccal mucosa Graft ( BMG), to a pananterior urethra stricture which includes restructuring the whole of the anterior urethra.
Many techniques have been in vogue for the graft urethroplasty. Many grafts have been used that vary from Buccal mucosa to full thickness skin graft and even intestinal mucosa and Fascia lata.
The surgery includes Open incision into the perineum and cutting across the urethral stricture and fixation of graft and dilatation of the narrowed area on a long lasting basis as close to natural self as possible. The same principle of cutting and tissue interposition to enlarge the diameter of the affected area is uniform across all techniques of urethroplasty.
These may include the graft from buccal mucosa or the oral cavity mucosa to be taken from both the sides.
The Stricture caused due to road side traffic accidents and pelvic trauma are a completely different ball game.
The success rate of endoscopic Internal Urethrotomy or dilatation is 30 % or more in primary or new cases and even lower in longer or recurrent strictures.
The success rate of urethroplasty in centres across the world is close to 85 to 90% on a long term basis.
The missing percentages need supplementation with endoscopic methods. Only very rarely a redo urethroplasty is required.
No, reliable options such as Endoscopy and Urethroplasty especially since the inception of Buccal Mucosa application has definitely made the disease more treatable and amenable to therapy.
No, STD in the form on Gonorrhoea has been known to cause penile urethral stricture but not all strictures are because of STDs.
The result can cause repeated Urinary Tract Infections and the back pressure changes can affect your kidneys also sometimes precipitating kidney failure
How many days do I have to stay in Hospital after endoscopic treatent for Urethral stricture disease
No more than couple of days usually if no other co morbidity has occurred.
Usually a patient is discharged in 3 to 4 days
Usually 4 weeks but in very complex cases upto 6 weeks is desirable
In Buccal Mucosa Urethroplasty the Inner lining of cheek is harvested to augment the stricture Urethra and to provide a reliable solution to the problem.
After the harvest the patient is allowed to sip and drink liquids the very same day but full complete oral diet is alllowed only after 2 days. The complete healing takes about 7 days to 2 weeks