Stricture Urethra: Solution to A Chronic Problem

Stricture Urethra means narrowing of urinary pipe or urethra. [Diag. 1 ]

There can be many reasons for developing a short or long narrowing in the urethra. These reasons can be :

1. Infections due to various types of bacteria
2. Injury to urethra - from accidents, etc.
3. Narrowing since birth
4. Following operation through urethra or catheterization.
5. Following passage of stones causing internal injury, etc.

These are some of the common causes for developing the narrowing of urethra.

If urethra or the water pipe becomes narrow, a person may have following problems:

1. Pain at the time of passing urine
2. Reduced stream or flow of urine.
3. 3. Blood in the urine or passing red urine
4. Discharge of pus from the urethra
5. Difficulty in passing urine
6. Inability to pass urine.
7. Sense of residual urine at the end of passing urine [unable to completely empty the bladder]
8. Pain in lower abdomen due to straining

A person can have all or some of the above complaints. If a person has these complaints, he should get in touch with an urologist for further evaluation. The urologist will ask you to undergo few tests.

Some of the basic tests which are necessary for diagnosis of stricture urethra are:

1. Uroflowmetry- where a person is asked to pass urine in a machine.
2. Ultrasonography- to see the effects on bladder & to see if the bladder is completely empty or not at the end of passing urine.
3. Urethrography or ultrasonography of urethra- to see the narrowing in detail. In addition, few supportive blood & urine tests may be done.

Once the diagnosis of stricture urethra is established, there are various forms of treatment for repair of this narrowing:

1. Internal Urethrotomy : This operation is done with the help of endoscope. There are no open cuts & is done quickly. Therefore this operation is very popular. Unfortunately, the recurrence of the stricture [the disease comes back after a few months or few years] is fairly common after this operation, especially in the region of penile urethra. The success rate of this operation varies from 40 to 60 %. Sometimes this incidence of recurrence can be reduced if a person is willing to self catheterize himself with a plastic tube.

2. Metal Dilatation : In this form of treatment, the stricture or the narrow part is made bigger with the help of steel rods. This method of treatment is no more popular due to high rate of recurrence & increase in the problem or stricture length.

3. Urethroplasty : This is the only long term solution for this chronic problem. In this operation, the damaged part of the urethra is removed or repaired & the new urethra is reconstructed with a complete or a partial tube. [Diag. 2 & 3] Since there is a normal tube placed in the place of the damaged tube, this operation gives good long term results. The success rate of this operation is about 95%. Once successful, the chance of recurrence of stricture or the narrowing is less than 3 to 5%. This is not the case with the other methods of treatment where recurrence of the disease is as high as 50%.

Urethroplasty is an open operation done by experts only. It is a delicate operation which can last for 3 to 5 hours depending upon how complex the stricture is.

As shown in the diagram, the damaged part of urethra is removed in this operation. A new tube is constructed by directly joining the good ends OR a new tube is constructed & put between the new both ends.

Sometimes if the remaining part of the damaged portion is not very bad, the tube is opened in that area & part of the tube is only newly reconstructed. The decision about which operation is to be performed is made at the time of operation.

This is a good operation to get rid of a long term problem which is notorious by its recurrence rate. Since it can be done now in Dhaka, persons affected by this problem should certainly take advantage of it to get rid of this chronic illness.

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