Can A Twisted Urethra Be Surgically Repaired?

• Facts
  • Urethral stricture facts
• Urethra Beefcake
  • What is the urethra?
• Definition
  • What is a urethral stricture?
• Causes
  • What are the risk factors and causes of urethral strictures?
• Symptoms
  • What are the symptoms and signs of a urethral stricture?
• Urologist
  • What type of doctor treats urethral obstacle?
• Diagnosis
  • How practise physicians diagnose urethral strictures?
  • Are there any special tests for diagnosing urethral strictures?
• Handling
  • What is the handling for urethral strictures?
• Surgery
  • What surgical options are bachelor for urethral strictures?
  • What is the recovery catamenia after surgery to repair a urethral stricture?
  • How are urethral strictures followed later repair?
• Prevention
  • Is it possible to preclude a urethral stricture?
• Prognosis
  • What is the prognosis for urethral stricture?
• Center
  • Urethral Stricture Center
• Comments
  • Patient Comments: Urethral Stricture - Symptoms
  • Patient Comments: Urethral Stricture - Diagnosis
  • Patient Comments: Urethral Stricture - Handling
• More
  • Find a local Urologist in your boondocks

Urethral stricture facts

Urethral strictures may crusade pain, or be asymptomatic.

• Urethral stricture disease is much more common in men than in women. In fact, urethral stricture is rare in women.
• Congenital urethral strictures (present at birth) are rare.
• Any inflammation of the urethra resulting from injury, trauma, previous surgery, or infection can cause urethral stricture.
• Symptoms of urethral stricture can range from no symptoms at all to consummate urinary retention.
• Imaging studies and endoscopic evaluations are of import tools in the diagnosis of urethral stricture.
• Medications have a limited part, and endoscopic and surgical procedures remain the mainstay of treatment for symptomatic urethral stricture disease.
• The overall prognosis for urethral stricture is good.

What is the urethra?

The urethra is a hollow tube that allows urine to leave the float. In men, the urethra starts from the lower opening of the float, the float neck, and traverses the unabridged length of the penis. In women, information technology is a shorter opening coming off the lower opening of bladder and is between 2.five to 4 centimeters (cm) in length. In both males and females, musculus (urethral sphincter) surrounds the urethra. The urethral sphincter closes the urethra to keep urine in the bladder, and just prior to urination, the sphincter muscle relaxes to permit urine to leave the float and pass through the urethra.

Picture of the urethra and associated structures

The posterior urethra and the inductive urethra are the two main segments of the urethra in males. The posterior urethra is composed of the prostatic and membranous urethra and extends from the float neck to the terminate of the verumontanum (the region where the ejaculate [sperm and fluids] enters the urethra). The anterior urethra is composed of the bulbar urethra, penile urethra, and the fossa navicularis. The corpus spongiosum completely surrounds the anterior urethra. Subdivisions of these segments include the following:

1. The urethral meatus, which is the opening at the tip of the penis
2. The fossa navicularis, which is the urethra located proximal to the urethral meatus and within the glans, head of the penis
3. The penile urethra, which is the urethra that goes from the urethral meatus to the distal border of the muscle, the bulbocavernosus muscle
4. The bulbar urethra goes from the beginning of the proximal urethra back to the finish of the membranous urethra. The bulbocavernosus muscle surrounds the bulbar urethra.
5. The membranous urethra is a short area of the urethra that extends from the proximal bulbar urethra to the distal verumontanum (the verumontanum is a small mound in the urethra where the ejaculatory ducts open up into and sperm enters the urethra).
6. The prostatic urethra is the urethra that goes from the end of the bladder cervix (outlet of the bladder) to the verumontanum.
7. The bladder neck, the outlet of the bladder

Urethral Stricture Symptom

Urinary Retention

Symptoms of urinary retention include the disability to urinate, which occurs when an private is not fully able to empty his or her float, despite having the urge to urinate. Urinary retention may be an acute (happening of a sudden) or longstanding (chronic) trouble in both men or women and can be associated with other bladder issues or abnormalities within the pelvis. Urinary retention is more common in men than women and increases in frequency every bit men historic period. Whatever condition that results in a physical blockage of the urethra (the tube through which urine exits the float) can result in the inability to urinate.

What is a urethral stricture?

Urethral stricture refers to chronic fibrosis and/or narrowing of the lumen of the urethra. Depending on the severity of the stricture, the flow of urine (urinary stream) may or may not be afflicted. Urethral stricture disease is associated with varying degrees of fibrosis of the spongiosum. Urethral stricture is the term applied to aberrant narrowing of the anterior urethra, whereas the American Urologic Association prefers the term stenosis for narrowing of the posterior urethra, which lacks spongiosum.

Urethral stricture is significantly more common in men and boys compared to women and girls. This condition is rare in females. The bulbar urethra is near commonly afflicted.

What are the hazard factors and causes of urethral strictures?

Whatever inflammation of urethra tin result in scarring, which then can lead to a stricture or a narrowing of the urethra. Trauma, infection, tumors, iatrogenic urologic interventions such as urethral instrumentation (catheter placement, cystoscopy), transurethral surgeries, treatment of prostate cancer, or whatever other cause of scarring may lead to urethral narrowing or stricture. Mechanical narrowing of the urethra without scar formation (developmental causes or prostate enlargement) can likewise narrow the urethra, only is not a stricture.

In adult countries, the well-nigh common crusade of urethral stricture is idiopathic (41%, no crusade identified) followed past iatrogenic (35%). Iatrogenic causes include strictures related to hypospadias (a built abnormality where the urethral meatus is located on the underside of the penis, anywhere from the perineum to simply brusk of the head of the penis) and strictures from endoscopic procedures (for example, cystoscopy or transurethral prostatectomy). In developing countries, trauma (36%) is the most common crusade of stricture.

The following are common causes of scarring or narrowing of the urethra:

• Trauma from injury or accidents with damage to the urethra or float (for example, falling on a frame of a bicycle between the legs, or a machine blow), straddle injuries
• Pelvic injury (fracture of the pelvic bones) or trauma
• Previous procedures involving the urethra (urinary catheters, surgeries, cystoscopy)
• Previous prostate surgery (TURP or transurethral resection of the prostate for prostate enlargement, radical prostatectomy for prostate cancer)
• Prostate enlargement
• Cancer of the urethra (rare)
• Infections of the urethra (sexually transmitted infections or STDs, urethritis, gonorrhea, chlamydia)
• Prostate infection or inflammation (prostatitis)
• Previous hypospadias surgery (a congenital birth defect in which the opening of the urethra is on the underside of the penis instead of the tip)
• Congenital malformations of the urethra, which rarely can cause urethral stricture in children
• Brachytherapy (placement of radiation seeds into the prostate) for prostate cancer
• Diaper-related irritation to the urethral meatus (opening at the tip of the penis)
• Inflammatory weather such as lichen sclerosus (previously referred to as balanitis xerotica obliterans in males), Reiter's syndrome

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What blazon of doctor treats urethral obstruction?

Most commonly, urologists manage urethral strictures. Urologists are doctors with training and specialization in the urinary arrangement.

How do physicians diagnose urethral strictures?

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Doctors make a diagnosis based on history, physical test, and one or more studies to determine the location and extent of the stricture.

When the medical history, physical examination, and symptoms are suggestive of urethral stricture, additional diagnostic tests may be helpful in further evaluation. Urinalysis (UA), urine culture, and urethral civilisation for sexually transmitted infections diseases (gonorrhea, chlamydia) are some of the tests that physicians may gild. A md may examine the prostate and screen for prostate cancer (manual exam and measurement of prostate specific antigen or PSA) depending on the history, symptoms, and historic period of the male person. A uroflow study may be obtained, whereby i urinates into a special drove container that tin can measure the rate of the menses of urine and the blueprint of the urine stream. In add-on, an ultrasound similar motorcar, a bladder scanner assesses the corporeality of urine left in the bladder (postvoid rest).

Often, imaging and endoscopic studies are necessary to confirm the diagnosis and identify the location, length, and extent of the narrowing from the stricture.

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Are there any special tests for diagnosing urethral strictures?

The post-obit are some common imaging and endoscopic tests in evaluating urethral stricture:

• Ultrasound of the urethra
• Retrograde urethrogram
• Cystography, filling and voiding (VCUG)
• Antegrade cystourethrogram
• Cystourethroscopy
• MRI and CT browse

Ultrasound of the urethra (ultrasound urethrography) is i of the radiologic methods in evaluating urethral stricture. An ultrasound probe can be placed forth the length of the penis (phallus) and determine the size of the stricture, degree of narrowing, and length of the stricture. This is a noninvasive method and usually does not require whatever special grooming. All the same, the location of the stricture limit an ultrasound of the urethra. Ultrasound of the urethra is more helpful in identifying strictures in the office of the urethra that passes through the penis. Currently, doctors may utilise ultrasound of the urethra in add-on to other studies, such as retrograde urethrogram (RUG) to define the stricture before surgery.

Retrograde urethrography is another X-ray test to evaluate urethral strictures. This test entails placing a small urinary catheter in the last part of the urethra, the urethral meatus (the opening at the tip of the penis). A wellness care professional gently inflates the balloon of the catheter to hold the catheter in place during the study. And then a physician injects a small amount (10-twenty cc) of an iodine contrast material into the urethra via the catheter and takes radiographic pictures under fluoroscopy to assess any obstruction or impairment to the flow of the contrast cloth that can suggest urethral stricture. This test provides useful information virtually the location, length of the stricture, and presence of other abnormalities.

Cystography, filling and voiding (VCUG) is helpful to look at the first function of the urethra, proximal urethra. In this study, an individual drinks water to fill his/her float and then voids under fluoroscopy.

Antegrade cystourethrogram is a similar exam that a health care professional person performs if there is a suprapubic catheter in place (a urinary catheter placed in the bladder through the skin in the lower belly). A health care provider injects iodine dissimilarity into the bladder via the catheter and its menstruation out of the urethra is radiographed nether fluoroscopy.

Cystourethroscopy is an endoscopic evaluation in which a minor instrument that is a thin tube (cystoscope) with a light within it and a photographic camera at the tip is inserted into the urethra to look directly at the within (lumen) of the urethra. A health intendance professional cleans the tip of the urethral opening to prevent infection and applies a local lubricant and anesthetic gel for condolement. Then a physician passes an endoscope through the urethra into the bladder to observe any anatomical or structural abnormalities and obtain a biopsy if he or she suspects urethral cancer. Cystoscopy is limited every bit the length of the stricture and the verbal location may non be able to be fully identified due to the size of the telescopic and the degree of narrowing of the urethra. In individuals with a suprapubic tube in place, a health care provider tin perform the cystoscopy with a flexible tube through the suprapubic tract, termed antegrade cystoscopy.

MRI and CT: Physicians use these studies less ofttimes to evaluate urethral strictures but in certain cases may be helpful, such as in individuals with a history of a fracture of the pelvic bone(s).

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What is the handling for urethral strictures?

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Once a stricture has developed, it will not get away. The role of medications in the management of primary urethral strictures is limited.

Surgery is the recommended treatment for individuals with symptomatic urethral strictures.

A medico may recommend surgery in the following circumstances:

• Astringent bug with urination, such as straining to urinate, weak stream, and urinary retention (inability to urinate)
• Stones in the bladder
• Recurrent urinary tract infections
• Increasing post-void residual (amount of urine left in float after urination)
• Failure of conservative measures to control symptoms (pain)

What surgical options are available for urethral strictures?

At that place are several surgical treatments bachelor for treating urethral strictures, some are more invasive than others. The treatment recommended may vary with the location, length, and severity of the stricture as well as an assessment of the risks and benefits of the procedure.

The mutual procedures include

• urethral dilation,
• direct vision internal urethrotomy (DVIU),
• urethral stent placement, and
• open urethral reconstruction.

When deciding the well-nigh appropriate form of treatment, it'south important to take into business relationship the stricture etiology, location, and severity, prior treatments, comorbidities, and patient preference. Physicians typically identify a urethral catheter after urethral stricture handling as it may serve as a stent around which the site of urethral intervention can heal.

Urethral dilation is a normally attempted technique for treating urethral strictures. The goal of urethral dilation is to stretch the scar tissue without injuring the lining of the urethra. A physician performs the process in the office under local anesthesia or in the operating room under general anesthesia. A wellness care professional person gently inserts thin rods of increasing diameters into the urethra from the tip of the penis (meatus) in club stretch the narrowing without causing any farther injury to the urethra. A health care provider typically places a catheter after the dilation and removes it approximately 72 hours afterwards the procedure, if information technology was uncomplicated. It may exist necessary to echo this procedure from time to time, every bit strictures may recur. All the same, the AUA guidelines recommend urethroplasty instead of repeated endoscopic direction for recurrent anterior urethral strictures following failed urethral dilation of directly vision internal urethrotomy. The shorter the stricture, the less likely it is to recur after a dilation procedure. Occasionally, physicians give patients instructions and dilation instruments (rods, lubricating gel, and coldhearted gel) to perform the urethral dilation at habitation every bit needed, particularly those patients who are non candidates for urethroplasty. A risk of urethral dilation is the gamble of making the stricture worse over the long term.

Direct vision internal urethrotomy (DVIU) is an endoscopic procedure performed nether general anesthesia. A doc inserts a sparse tube with a camera (endoscope) into the urethra to visualize the stricture (as describe in earlier section). And then a physician passes a tiny knife through the endoscope to cutting the stricture lengthwise to open up the stricture and widen the urethra. A doc then inserts a Foley catheter (urinary catheter), which is kept in place for a few days to a calendar week while the urethral incision is healing. For individuals with a soft stricture that is short, <1 cm long, located in a segment of the urethra called the bulbar urethra, DVIU has a stricture-free rate of 50%-70%. The success of DVIU in other locations and more dense strictures is often less. Complications after DVIU include haemorrhage, pain, urinary tract infection (UTI), troubles with erections, and recurrent stricture. Use of the light amplification by stimulated emission of radiation to open up up the scar tissue does non appear to exist any better than using the pocketknife. DVIU may be repeated if the stricture recurs, still, as with urethral dilation, urethroplasty should be offered for recurrent anterior urethral strictures after failed DVIU.

Bladder neck contracture (vesicourethral stenosis) may occur after surgical management of prostate disease, including transurethral prostatectomy for benign prostatic hypertrophy (BPH) and radical prostatectomy for prostate cancer. Dilation or incision initially treats float neck contracture. Recurrent bladder neck contracture may require surgical reconstruction.

Urethral stent placement is some other endoscopic procedure aimed at treating urethral strictures. Depending on the location of the stricture in the urethra, a wellness intendance provider may laissez passer a closed tube (stent) through an endoscope to the area of the stricture. Once it reaches the proper location, a physician will open the stent to form a patent tube or conduit for urine to period. This may be helpful in individuals who are likewise sick to undergo surgery that is more than extensive. Data on long-term success rates of urethral stents is lacking. Complications of urethral stent placement include hurting, dribbling after urinating, change in position of the stent (stent migration), stent malposition, and blockage of the stent.

Open up surgery, urethroplasty, is the gilt standard. It has better long-term success rates than other therapies. Doctors may recommend unlike types of urethroplasty depending on the location and extent of the stricture. There are two types of urethroplasty techniques: tissue transfer procedures and non-tissue transfer procedures. Performance of tissue transfer procedures may crave one stage or multiple stages (multi-stage) depending on the availability of tissue, extent, and location of the stricture.

Excision and master anastomosis urethroplasty is a non-tissue transfer procedure: This procedure involves open surgical removal of the scar and reconnection of the urethra. This process works well for curt strictures (< 2 cm) located in a special area of the urethra, the bulbar urethra. A catheter left in place after the procedure allows the area to heal. The duration of the catheter will vary with surgeon preference. The success rate of this procedure is up to 90%. Risks of this procedure include risks of infection, bleeding, pain, recurrent stricture, and fistula (a communication between the urethra and the pare), and dribbling subsequently urination.

Augmented urethroplasty involves tissue transfer. For case, if the stricture is long and/or located in the penis, the stricture may be opened and a flap or graft of tissue is sewn on top of the opened urethra to increment the quotient of the urethra (single stage) or less commonly replaced with a tube, made from surrounding tissues, such equally nearby skin or from tissue removed from other areas in the trunk such equally from the within of the cheek (buccal mucosa) (multi-stage). In a multi-stage procedure, the scarred urethra is typically removed and a slice of tissue (graft of flap) is sewn into the area. Several months subsequently the tissue is then made into a tube. To let the tissue to heal and minimize urine leakage during healing, a catheter is left in place. The elapsing of the catheter may vary with the extent and location of the stricture and whether the procedure is being performed in a unmarried stage or in two stages. Individuals with lichen sclerosis related stricture disease should not use penile or genital skin for the urethroplasty due to possible involvement of this tissue with the lichen sclerosis. Erectile dysfunction may occur transiently after urethroplasty with resolution in nearly all affected individuals by six months postoperative. Ejaculatory dysfunction (pooling of semen, decreased ejaculatory forcefulness, discomfort with ejaculation, and decreased semen volume) is reported in upward to 21% of men follow urethroplasty for bulbar urethral strictures.

Pelvic fractures may results in urethral injury and subsequent stricture. The risk of developing a stricture is related to the initial treatment of the injury. If a suprapubic tube is placed at the time of the pelvic injury, there is a high likelihood that a stricture will form. The stricture is repaired when the patient has healed from the other injuries and is treated with excision of the stricture and reapproximation of the ends of the urethra. In some cases, a catheter is able to exist passed through the urethral injury into the bladder (chief realignment) at the time of injury, and the urethra is allowed to heal over the catheter. This realignment of the urethra decreases the gamble of urethral stricture formation by about 30% and makes surgery for repair of the stricture, if it occurs, easier. Success rates with repairs of urethral strictures from pelvic fractures is about 90%-98% with excision of the stricture and bringing the ends of the urethra together (reapproximation). Complications of pelvic fractures include haemorrhage, infection, and erectile dysfunction. Complications of the urethral stricture repair include bleeding, infection, and urinary incontinence.

In select circumstances, a perineal urethrostomy may be preferred as a long-term treatment alternative to urethroplasty. A perineal urethrostomy involves making an incision into the urethra, urethrothrotomy, and opening the urethra and sewing it to the perineum (anterior to the rectum and behind the scrotum). With a perineal urethrostomy, the individual would sit on the toilet to urinate.

The treating urologist would recommend the procedure that would be the best option for each individual. As with any medical procedures, at that place are some degrees of risks and complications associated with whatever of these operations.

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What is the recovery period subsequently surgery to repair a urethral stricture?

The recovery menses later surgery will vary with the procedure performed, duration of catheterization, surgeon preference, and overall health condition. A catheter (Foley catheter) is left in the penis later on virtually all surgeries for handling of a urethral stricture. How long the catheter remains in place will depend on the procedure performed and surgeon preference. Typically, the catheter is left in place for at to the lowest degree 72 hours. In some cases, a suprapubic tube (tube that goes through the lower belly into the bladder) may be left in place to drain the urine in addition to the catheter. With less invasive procedures, the duration may be shorter. The discomfort related to the process will as well vary with much less discomfort with the less invasive procedures, urethral dilation, and internal urethrotomy. With the more extensive surgery, urethroplasty, a more than prolonged course can be expected, varying with the extent of the surgery. Procedures such as dilation and internal urethrotomy are outpatient procedures, whereas more circuitous repairs may exist associated with an overnight stay in the hospital. Follow-up is required afterwards urethroplasty to ensure that the repair is healing well and complications such as a fistula (communication between the urethra and the skin), recurrent stricture, and diverticulum (outpouching of the urethra) are identified and treated if they occur.

How are urethral strictures followed after repair?

At that place is a chance of recurrence of the urethral stricture, and thus follow-upward is essential. The physician will ask questions about the force of urine stream, frequency of urination, feeling of complete or incomplete float emptying, direction of the urine stream, and other symptoms of urethral strictures. During such follow-up visits, you may exist asked to void into a special drove device, uroflow, to measure the speed of urination and the menstruation of urination. A small ultrasound probe may exist placed on the lower part of the belly after urination to measure the amount of urine remaining in the bladder (mail-void residual). In some cases, a cystoscopy may be performed to look directly at the expanse of urethra that was repaired.

Urethral strictures in children may outcome from diaper irritation (meatal stenosis), trauma, prior surgery or instrumentation, or may be congenital. They will frequently appear with similar symptoms as those in adults.

Meatal stenosis is a narrowing of the opening at the tip of the penis and is felt to occur from diaper irritation in circumcised boys. It may likewise occur afterward hypospadias repair. Symptoms include decreased or deflected urine stream. Performing a meatotomy/meatoplasty, burdensome the scarred span of tissue and cut it later, is successful in 98%-100% of boys.

For urethral strictures in the penile urethra to the bulbar urethra, dilation is not recommended. DVIU volition be successful in approximately 50% of patients. Excision of the stricture if feasible and primary reattachment of the urethral ends is most effective. When this cannot be accomplished, so a patch graft of buccal mucosa is successful.

Is information technology possible to prevent a urethral stricture?

In full general terms, urethral stricture is not preventable as most common causes are related to injury, trauma, instrumentation, or unpreventable medical weather. Sexually transmitted infections such as gonorrhea or chlamydia are less common causes of urethral stricture, and they tin can be potentially prevented by practicing safety sex. Judicious use of catheters and instrumentation may decrease the risk of urethral strictures.

What is the prognosis for urethral stricture?

In full general, the outlook on urethral stricture is favorable with success rates upwards to 90%-98%. A thorough initial evaluation may help place the virtually appropriate initial treatment strategy and thus subtract recurrence rates. Repeated dilation and DVIU is discouraged as they result in further urethral injury and longer and more than all-encompassing strictures.

References

American Urological Association. "Male Urethral Stricture." 2022. <http://www.auanet.org/guidelines/male-urethral-stricture-(2016)>.

Broghammer, Joshua A. " Urethral Strictures in Males." Medscape.com. November. 21, 2022. <http://emedicine.medscape.com/article/450903-overview>.

Buckley, J.C., C. Heyns, P. Gilling, and J. Carney. "SIU/ICUD Consultation on Urethral Strictures: Dilation, Internal urethrotomy, and stenting of male person anterior urethral strictures." Urology 83 (2014): S18-22.

Chapple, C., et al. "SIU/ICUD consultation on urethral strictures: The direction of anterior urethral stricture illness using substitution urethroplasty." Urology 83 (2014): S31-47.

Gomez, R.G., et al. "SIU/ICUD Consultation on Urethral Strictures: Pelvic fracture urethral injuries."Urology 83 (2014): S48-58.

Herschorn, S., et al. "SIU/ICUD consultation on urethral strictures: posterior urethral stenosis after handling of prostate cancer." Urology 83 (2014): S59-70.

Kaplan, G.Due west., et al. "SIU/ICUD consultation on urethral strictures: urethral strictures in children." Urology 83(iii Suppl) Mar. 12, 2022: S71-iii.

Latini, J.M., et al. "SIU/ICUD consultation on urethral strictures: epidemiology, etiology, anatomy, and nomenclature of urethral stenosis, strictures, and pelvic fracture urethral disruption injuries." Urology 83 (2014): S1-vii.

Lumen, Nicolaas, et al. "Etiology of Urethral Stricture Affliction in the 21st Century." The Journal of Urology 182.three Sept. 2009: 983-987.

Stewart, 50., et al. "SIU/ICUD consultation on urethral strictures: anterior urethra-lichen sclerosus." Urology 83 (2014): S27-30.

Can A Twisted Urethra Be Surgically Repaired?,

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