Shorter strictures are treated with endoscopic procedures, but longer strictures and failed strictures are treated with various complex reconstructive procedures using skin from penis or mucosa from inner aspect of chin or tongue. Male urethral strictures and their management ncbi. Urethral stricture disease tom walton january 2011 2 poor results for nonbulbar and multiple strictures. The current gold standard, retrograde urethrography rug, allows for accurate diagnosis, staging, and delineation of urethral strictures, and remains a cornerstone in the management of urethral stricture disease. Another urologic condition we see and treat regularly is urethral strictures. 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. Urethral stricture stenosis is a narrowing of the urethral lumen. A urethral stricture is a narrowing of the urethra caused by scarring, which functionally has the effect of obstructing the lower urinary tract.
The treatment of panurethral strictures intech open. Less common causes include congenital urethral strictures and those resulting from malignancy. The diagnosis of urethral stricture begins with a history and physical exam. Acrsar practice parameter for the performance of adult. Urethral stricturestenosis is a narrowing of the urethral lumen. Hydronephrosis and renal failure may also happen from backup of urine into the kidneys from a poorly draining bladder. Mild strictures can be managed with simple urethral dilation that may be curative. Permanent urethral stents places endoscopically designed to be incorporated into the wall to provide a patent lumen most useful in short strictures located in the bulbar urethra and in elderly patients who can. Original article comparison of holmium laser combined. The treatment options for urethral stricture vary in their success rates. Introduction extensive or panurethral strictures that involv e both the pendulous and bulbar urethra were difficult to treat surgically. Comprehensive analysis of etiology on the prognosis of urethral. To date, the morbidity of urethral stricture disease among american men has not been analyzed using national datasets. An open urethroplasty may be done for longer strictures.
Urinary tract strictures university of california, san. Due to the lockdown in place, you might face disruption in our medical services and delivery of equipment. Urethral stenosis is narrowing of the posterior urethra, i. Fortunately, there is a curative surgical treatment. In children, urethral strictures most often follow reconstructive surgery for congenital abnormalities of the penis and urethra, cystoscopy and occasionally may be congenital. The treatment of urethral strictures can be divided into three main categories. According to a national practice survey of board certified urologist in the united states most urologists treat on average 620 urethral strictures yearly. It is typically performed under local or general anesthesia. Bacterial urethritis can also lead to stricture around 20% of cases.
The urethras main job in males and females is to pass urine outside the body. However, posterior urethral trauma due to road traffic accidents is common in developing countries. Causes urethral strictures are generally caused by trauma such as straddle injury bicycle bar, sports injury, fence straddle. External trauma generally causes partial or complete disruption of an otherwise normal urethra.
Injury of the urethra and pelvic is a common cause. 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. For long and nontraumatic strictures of the anterior urethra, the aim is. Urethral strictures can cause numerous signs and symptoms that range from mild to severe.
Strictures can be prevented in people who intermittently. Staged urethroplasty in the management of complex anterior. This thin tube also has an important role in ejaculation for men. This is referred to as urinary retention, and is a medical emergency. Urethral stricture stricture lichen sclerosus pelvic fracture urethral injury bladder outflow obstruction urethroplasty buccal mucosa graft. If you continue browsing the site, you agree to the use of cookies on this website. The outcome studies on dviu procedure have shown a wide range of success rates. The management of urethral stricture in women includes urethral dilatation, urethrotomy, clean isc and substitution urethroplasty 10,15. Original article minimally invasive percutaneous suprapubic. Urethral strictures most commonly result from injury, urethral instrumentation, infection, noninfectious inflammatory conditions of the urethra, and after prior hypospadias surgery. Patients will often describe certain risks factors see above, and for those patients with the symptoms, described above, a thorough investigation is required to rule out urethral stricture or complications related to one.
Current trends in urethral stricture management sciencedirect. Among the causes of urethral stricture, the most common cause is trauma and secondary to surgical instrumenta tion, such as urethral catheterization, transure thral resection, and surgery for hypospadias 3, 4. We advocate the use of the kulkarni technique for full length strictures of the urethra due to ls. There are no medical treatments for urethral stricture, though early treatment of urethritis or utis with antibiotics is an important part of the treatment of strictures. Urethral strictures are rarely the fault of the patient.
This involves the passage of sequentially larger instruments through the stricture into the bladder in order to open up the scar tissue. Direct vision internal urethrotomy dviu is a common intervention procedure for anterior male urethral strictures less than two centimetres in length. Current trends in urethral stricture management asian journal of. Urethral trauma associated with urethral catheterization is a potential cause of urethral rupture, uroabdomen and urethral strictures in cats. The primary outcome was the incidence of isolated bulbar urethral strictures among patients with hypospadias who required reconstructive surgery. Male urethral stricture american urological association. If a urethral stricture involves only the urethra or superficial spongy tissues. Urethral stricture disease is defined as a narrowing of the urethra between its origination at the bladder and its outlet at the penis tip. Urethral stricture is an abnormal narrowing of the urethra, the tube that carries urine out of the body from the bladder. A urethral stricture is when a portion of the urethra is abnormally narrowed. Urethral stricture, a common urinary tract disorder, is a disease with a long history, reported since ancient times 1, 2.
Urethral strictures remain a reconstructive dilemma, due to high. Hypospadias repair is the most common surgery to cause urethral stricture disease, but prior instrumentation can also cause stricture disease. Some of the signs of a urethral stricture include weak urine flow or reduction in the volume of urine, urinary urgency, pain during urination, incontinence, pain in the pelvic or lower abdominal area, urethral discharge, penile swelling, the presence of blood in the semen andor urine. Urethral strictures in men urological health the information in the publication is not intended to convey medical advice or to substitute for direct consultation with a qualified medical practitioner. Sep 21, 20 what are the causes for urethral stricture. Pdf most urethral strictures are either idiopathic or iatrogenic secondary to urethral instrumentation or failed surgery for hypospadias. Pdf urethral stricture disease in men researchgate. Urethral strictures arise from various causes and can result in manifestations. From urethral stricture causes and urethral stricture symptoms, to urethral stricture treatments, well give you the basics of urethral stricture so that you will be prepared if it happens to you.
Urinary tract strictures what is urethral stricture. Other causes of urethral strictures include infection including sexually transmitted disease, hypospadias, skin conditions most commonly lichen sclerosus, trauma most commonly pelvic fracture, and radiation therapy. If urethral dilation cannot correct the condition, you may need surgery. But they can usually be fixed in their early stages. Urethral strictures arise from various causes and can result in a range of manifestations, from an asymptomatic presentation to severe discomfort secondary to urinary retention. Staged urethroplasty in the management of complex anterior urethral stricture disease staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult anterior urethral strictures not amenable to onestage graft or flap reconstruction. Book an appointment at portea to get expert nursing care for urethral stricture in the comfort of home. Urethral dilation urethral dilation is a commonly used technique for treating urethral strictures. We sought to analyze the morbidity of urethral stricture disease by measuring the rates of urinary tract infections and urinary incontinence among men with a diagnosis of urethral stricture. Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra.
Management of urethral strictures is complex and depends on the characteristics. The morbidity of urethral stricture disease among male. If the narrowed area is short and not near the muscles that control the exit from the bladder, the stricture may be cut or dilated. The rate of visits to physician offices for urethral stricture disease in men ranges from 229 to 312100,000 visits. Incidence, causes, and complications of urethral stricture. Dec 30, 2018 urethral strictures arise from various causes and can result in a range of manifestations, from an asymptomatic presentation to severe discomfort secondary to urinary retention. 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, and recommend. Accurate imaging of urethral strictures is critical for preoperative staging and planning of reconstruction. Some patients with severe urethral strictures are completely unable to urinate.
Beaumont is one of the few health systems in michigan who have fellowshiptrained urologists who are experts in the repair of complex urethral strictures. Urethral strictures have multiple causes including prior urinary tract infection, catheter placement, injury to the urethra, pelvic radiation. April 2020 british association of urological surgeons baus limited what happens on the day of the. The treatment is controversial and particularly the relative roles of urethrotomy or urethral dilatation on the one hand and urethroplasty on the other. A urethral diverticulum may develop, sometimes accompanied by abscess formation and, rarely, a fistula with extravasation of urine into the scrotum and perineum.
Anastomotic urethroplasty in expert hands provides excellent longterm success. San francisco, ca 941430738, usa nih public access author. Management of urethral stricture in women request pdf. Pdf male urethral strictures and their management researchgate. In adults, urethral strictures from instrumentation trauma may occur after prostate surgery and urinary catheterization. April 2020 british association of urological surgeons baus limited what is a urethral stricture. Management of urethral stricturesstenosis is complex and requires careful evaluation. Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i. Urethral strictures are common and increasingly common in an ageing population.
This technique may also be used in patients with previous failed bulbar urethroplasty or repeated urethrotomies. A urethral stricture is internal damage to the urethra caused by injury, such as straddle or pelvic fracture trauma. Information about your condition from the british association. The costs associated with urethral strictures are compounded by patient morbidity, including urinary tract infections utis, incontinence, and stricture recurrence 2. A urethral stricture can also cause inflammation of the prostate. The pathology of urethral stricture disease is poorly understood. Urethral stricture is usually suspected when urethral. Mechlins postoperative instructions for your procedure. A stricture is essentially a scar that limits urine flow.
Male urethral strictures and their management lindsay a. Surgery is the only treatment for people with uncontrolled symptoms of urethral narrowing. The clinical manifestations, diagnosis, and management of urethral strictures in men are discussed here. Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious. Strictures can also be caused by pelvic fractures from major trauma. A urethral stricture is a tightening or scarring of the urethra the tube that allows urine to flow out of the body from the bladder through the penis. Minimally invasive percutaneous suprapubic cystolithotripsy. Breyer department of urology, university of california, 400 parnassus avenue, suite a610, box 0738, san francisco, ca 941430738, usa abstract male urethral stricture disease is prevalent and has a substantial impact on quality of life and. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture which is. Novel surgical technique for female distal urethral stricture disease.
Pdf male urethral stricture disease is prevalent and has a substantial impact on quality of life and healthcare costs. Symptoms include painful urination, urinary retention, and pelvic pain. Urethral stricture symptoms and causes mayo clinic. It may also be caused by pressure from a growing tumor near the urethra, although. The treatment of panurethral strictures yuemin xu and chao feng department of urology, sixth people s ho spital, urethral reconstruction center, jiaotong university of sh anghai, shanghai 200233, china 1. What you need to know about a urethral stricture what is a urethral stricture. However, for patients who selfcatheterize, care must be taken to practice sterile procedures and to use a lubricant jelly to ease the. Urethral strictures may cause problems with urination, including in certain cases the complete inability to urinate, which is a medical emergency. Were going to take a detailed look at urethral stricture. Surgeons should offer urethroplasty to patients with penile urethral strictures, given the expected high. It can result from a multitude of aetiological factors, with iatrogenic causes, trauma and idiopathic strictures responsible for most cases in the contemporary world. Urinary tract strictures 080615 ucsf department of urology.
The canadian urological association disclaims all liability and legal responsibility howsoever caused, including negligence, for the. Patients with urethral stricture disease commonly have difficulty urinating or a weak stream. 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. Retrograde urethrogram rug is the main diagnostic method to find anterior urethra stricture and help find the length of the stricture. A urethral ureethrul stricture involves scarring that narrows the tube that carries urine out of your body urethra. These conditions greatly impact the health and quality of life of patients. The consequences of this obstruction can enormously. Robert sabbagh surgical foundations program director, associate professor.
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. A urethral stricture is a scar that surrounds the urethra urethra the tube that carries urine from the bladder to the tip of the penis for a short or long distance and blocks the flow of urine. The most obvious sign of urethral stricture is a weakened urinary system. A urethral stricture, or narrowing of the urethra, may cause decreased urine output.
Another inflammatory disease associated with distal urethral stricture is balanitis xerotica obliterans, a chronic inflammatory disease whose exact etiology is unknown. This condition may be caused by inflammation or scar tissue from surgery, disease or injury. However, for patients who selfcatheterize, care must be taken to practice sterile procedures and to use a lubricant jelly to ease the passage of the catheter through the urethra. Isolated bulbar urethral strictures in patients presenting. Bulbar urethral trauma is comparatively rare and typically results from a straddle injury. Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture disease is still a prevalent problem with an estimated incidence of 0. Establishing effective drainage of the urinary bladder can be challenging, and a thorough understanding of urethral anatomy and urologic technology is essential. This use of genital skin leads to high recurrence rate. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Jul 30, 2014 urethral strictures 11th june,2014 dr. Emergency management includes suprapubic tube placement. A common cause of urethral stricture in boys is trauma from straddle injury.
Management of urethral strictures stenosis is complex and requires careful evaluation. Essentially, a urethral stricture is a constriction within your urethra, the thin tube that. Theconsumershandbookofurologicalhealth 166 apaininthescrotumandurethralstrictures dr. Information about your condition from the british association of urological surgeons baus published.
Classification systems exist for anterior and posterior urethral trauma and for urethral cancer but no commonly accepted staging system currently exists for anterior urethral strictures. Urethral stricture can cause numerous symptoms, ranging from mild to severe. Urethral strictures societe internationale durologie. Male urethral stricture disease is prevalent and has a substantial impact on quality of life and healthcare costs. Patients with any other urethral strictures, including contiguous strictures, were excluded.