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Urethral stricture: narrowing of the urethra

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Strictures are spoken of primarily in urology, meaning a clinically significant narrowing of the lumen of the ureter or urethra.

The term “stricture” (lat. “compression, compression, squeezing”) comes from the same root as the name of the genus of boas: boa constrictor in literal translation means “knot-noose”. Strictures are spoken of primarily in urology, meaning a clinically significant narrowing of the lumen of the ureter or urethra, and also in gastroenterology (stricture of the esophagus or intestines). For other branches of medicine, the terms-synonyms “obliteration”, “obstruction”, “obturation”, “stenosis”, etc. are traditional and generally accepted.

In the general flow of urological patients, urethral strictures occur with a frequency of 0.5-1.5%, and there are up to four times more men with this pathology than women. This is explained quite simply – by sexual dimorphism and the corresponding anatomical differences: a much shorter, wider and straighter, female urethra often acts as a springboard for all sorts of ascending urogenital infections, but men are much more likely to suffer from urethral strictures (especially traumatic etiology).

As an independent problem, not associated with other diseases, urethral stricture is rare. As a rule, an immediate cause is found in the anamnesis or during a diagnostic examination, which led to the narrowing of the urethra.

The reasons

Urethral stricture can be congenital (malformation of intrauterine development) or acquired. In some cases, however, it is not possible to identify any factors that, at least theoretically, could narrow the lumen of the urethra; in these cases, one speaks of an idiopathic stricture, i.e. about a purely individual and etiologically unclear pathology. Congenital and idiopathic strictures account for no more than 2% of the total.

In the etiopathogenesis of acquired strictures, traumatization is the leading cause, and the range of such injuries is very wide: from thermal and chemical burns of the urethra to injuries received during extreme or experimental sex; from birth (in women) and radiation injuries to severe polytrauma with a fracture of the pelvic bones, received in an accident or at work.

About 15% of urethral strictures are iatrogenic, i.e. due to medical intervention. Such procedures include endoscopic examinations and operations on the organs of the genitourinary system, catheterization, etc., especially if such manipulations are performed repeatedly.

Approximately the same proportion falls on strictures caused by infectious and inflammatory diseases of the genitourinary system. The walls of the urinary tract are thin, almost inelastic and very vulnerable to any degenerative-dystrophic processes; due to inflammation (especially chronic) and fibrous scarring, they coarsen and thicken, which leads to a narrowing of the lumen. According to published statistics, gonorrhea and chlamydia are the most dangerous in this regard, however, urethritis of any other origin can lead to a reduction in diameter.

In addition, the cause of degeneration of the walls of the urethra may be insufficient blood supply and tissue nutrition (which occurs, in particular, in diabetes mellitus, atherosclerosis, arterial hypertension and other systemic diseases).

Symptoms

By definition, any pathology negatively affects the functioning of the affected organ or tissue. Since the main (and in women the only) function of the urethra is to ensure the unimpeded excretion of urine from the body, this process is primarily disturbed. The most typical symptoms are:

  • soreness, cramps, difficulty urinating (especially at the beginning);
  • bifurcation, splashing, weakening of the jet (in some cases it has to be supported by significant tension in the abdominal muscles);
  • feeling of incomplete emptying of the bladder with frequent repeated urges;
  • uncontrolled “leakage” of urine in underwear;
  • discharge from the urethra during infections, – primary or secondary (attached due to stagnation of urine);
  • blood impurities in the urine or, in men, in the semen.

 

In the most pronounced, extreme cases, the lumen of the urethra is completely blocked; the so-called. Acute urinary retention is a life-threatening condition that requires emergency medical care.

However, an incomplete, partial blockade of the outflow of urine is fraught with the development of severe complications: cystitis , pyelonephritis , prostatitis , hydronephrosis, urolithiasis , renal failure, etc.

Diagnostics

In addition to collecting complaints and anamnestic information, as well as a standard urological examination (in men, it includes a digital rectal examination of the prostate gland), if urethral stricture is suspected, laboratory blood and urine tests (including bacteriological examination) are prescribed. Of the instrumental methods, they almost always resort to urodynamic diagnostics, i.e. to procedures that allow tracking the passage of urine through the urinary tract (X-ray contrast urethrography, cystourethrography using MSCT, uroflowmetry, etc.). In some cases, an ultrasound of the bladder is prescribed; to assess the condition of the walls of the urethra “from the inside” allows endoscopy. Sometimes catheters of various diameters are used to measure the residual lumen.

Treatment

In the light of the foregoing, it is obvious that with urethral stricture, medical, and even more so, “folk” methods of treatment cannot be effective in principle.

The primary task is to eliminate or prevent ishuric syndrome (complete or partial retention of urine) and restore normal urination. The most sparing, low-traumatic methods of this kind, but also the least reliable in terms of preventing relapse, are various options for bougienage and balloon catheterization of the urethra. In some cases, urethral stenting is used – a special dilator is introduced into the narrowed area of ​​​​the urethra, which mechanically does not allow the lumen to close; here, however, the risk of spontaneous migration of the stent is quite high.

With severe and extended strictures (more than 2 cm long), surgical intervention is necessary. Depending on the specific clinical situation, various methods are used, including high-tech methods of urethrotomy, urethroplasty, urethrostomy; with acute urinary retention, sometimes it is necessary to resort to trocar cystostomy – the surgical formation of an artificial urinary tract with access through the anterior abdominal wall, followed by a reconstructive operation after the elimination of urethral stricture.

A thorough examination is mandatory in order to reliably identify the causes of stricture formation, since without eliminating these causes (for example, a fibrosing infectious-inflammatory process), even the most radical treatment is a palliative, and relapse is almost inevitable. In the prognostic aspect, one of the most important factors is also the timeliness of seeking help.

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