Urethra stenosis is a condition in which there is stenosis in the urethra, a tube-shaped structure located between the bladder and the urinary exit hole. The urethra is normally wide enough for urine to flow freely through it, but flow is interrupted when there is a narrowing of the urethra. This health problem, which is mostly seen in men, affects the entire urinary system (urinary excretory system) function negatively and can lead to very serious consequences such as kidney loss. Its prevalence among men in developed countries is approximately 0.9%.
What is the urethra?
For those who are wondering what the urethra means, the urethra is a tube-shaped urinary canal that starts from the bladder and ensures the excretion of urine from the body. . It is a long tube that runs through the penis in men and is responsible for carrying semen as well as urine. It is quite short in women compared to men and is located just above the vagina. Urethral problems can be seen in both sexes due to different reasons such as aging, disease or trauma. The urethra starts from the bladder and opens out of the body. The urinary system also has a pair of tube-shaped ureters, called ureters, that run from each kidney to the bladder. As in the urethra, ureteral strictures are important disorders of the urinary system. Ureter and urethral stenosis, if left untreated, may pave the way for serious diseases such as kidney infections and kidney stones. It is an obstructive disorder with potentially serious consequences for the entire urinary tract. Scar tissue is a scar that is formed during the healing of wounds in the body and contains cells in a different structure from the normal tissue in the area. Urinary tract stricture caused by scar tissue in the urethra causes obstructive and irritating urinary symptoms and can eventually lead to a life-threatening complication such as kidney loss if left untreated. Urethral strictures may occur as a negative result of some medical procedures performed for diagnostic or therapeutic purposes.
What Causes Urethral Stenosis?
Urethral stricture, swelling or scar tissue in the canal due to surgical procedures � It may occur after infection or injury. Rarely, the pressure of a tumoral formation near the urethra into the duct is the cause of the stricture. Urethral manipulation is the most common cause of urethral stricture. Approximately 45% of urethral strictures occur due to urethral manipulation such as endoscopy, surgery, brachytherapy, while the cause of 30% cannot be found. 20% of them are caused by infections that cause inflammation in the urethra. Factors that can be counted among the causes of urethral stenosis include:
- Entering the urethra with an endoscopy or similar instrument
- Prostate Brachytherapy: Brachytherapy for prostate cancer Receiving treatment may result in urethral stricture. Brachytherapy is a form of radiotherapy.
- Prostatectomy: Surgical procedure in which part or all of the prostate gland is removed.
- Installation of the Urethral Catheter: Intermittent or permanent catheterization into the urethra to drain the urine from the bladder
- Prostate enlargement
- Prostatitis: Inflammation of the prostate
- Injury or trauma to the groin area or urethra
- Urethra or prostate cancer
- Sexually Transmitted Diseases: Sexually transmitted diseases such as gonorrhea and chlamydia can cause urinary tract narrowing if they are not treated.
- Bacterial Infections: Untreated recurrent infections may cause stenosis due to inflammation.
- Surgical Treatment of Hypospadias: Hypospadias is a congenital anomaly in which the urethral opening is located under the penis instead of the tip.
- Balanitis Xerotica Obliterans: It is a lichen sclerosis disease that affects the penis in men. It causes inflammation of the foreskin and glans penis.
- Hip fractures
- Congenital Anomaly: Rarely, babies may be born with a stenosis in the urethra due to a congenital defect.
What are the Symptoms of Urethral Stenosis?
Urethral stenosis may present with many symptoms ranging from mild to severe, depending on the degree of obstruction in the duct. Some of these symptoms may be:
- Weakness in the flow of urine
- Reduction in the amount of urine
- The need to urinate frequently
- Feeling of incomplete emptying of the bladder after going to the toilet
- Burning while urinating
- Loss of bladder control and urinary incontinence
- Urethral discharge
- Dark urine
- Blood in the urine
- Sudden need to urinate
- Pain when urinating
- Prolongation of urination
- Inability to urinate
- Frequent urinary tract infections
- Pain and swelling in the penis and surrounding tissue in men, blood in the semen and inflammation of the prostate
How is the Treatment of Urethral Stenosis?
The treatment for urethral stricture is decided according to the findings obtained by tests and imaging methods. Treatment options are as follows:
- Urethral Catheterization: A urinary catheter is inserted into the urethra to drain the urine accumulated in the bladder due to obstruction. It is a treatment option for cases of temporary stenosis. It is performed to prevent recurrence of stenosis after treatment. It is the process of widening the urethra by using rigid catheters at regular intervals. The purpose of urethral dilatation is to stretch the scar tissue without damaging the lining of the urethra.
- Urethroplasty and Urethral Reconstruction: It is the most permanent treatment option for urethral stricture. It can be performed in two ways as cutting and removing the narrow urethra, suturing the remaining healthy ends end-to-end, or restructuring (reconstruction) with tissues taken from other parts of the body. are entered. The stenosis is widened by cutting or laser burning.
- Implanted Stent or Indwelling Catheter: In patients with a severe stricture who do not want surgery, treatment can be done by placing an indwelling stent to keep the urethra open or an indwelling catheter to drain the bladder. However, these methods have several disadvantages such as bladder irritation and urinary tract infection risk.
After Urethra Stenosis Surgery How is the Healing Process?
Urethral stricture surgery can be performed in two different ways, urethroplasty or endoscopic urethrotomy. Recovery time after urethral stricture surgery varies according to the procedure, catheterization time of the patient and general health status. After almost all surgeries for the treatment of urethral stricture, a catheter (urinary tube) is left in the urethra. How long the catheter will remain in place is determined by the procedure performed and the doctor's decision.
What Happens If Urinary Tract Stenosis Is Not Treated?
If urethral stricture is not treated, it may lead to serious disorders such as kidney infections and kidney stones. can prepare. It may cause urine to accumulate in the urinary tract by preventing the urine output, thus leading to impaired bladder function and kidney damage.
Why Does Urethral Stenosis Recur? and the risk of recurrence differs according to the type of surgery performed. Stenosis longer than 1 cm has a very high risk of recurrence. If the connective tissue around the stenosis is dense, the risk of recurrence is high. Urethroplasty for urethral stricture is the longest lasting treatment method, regardless of the type of surgery performed. However, although rare, there is still a risk of recurrence after a while. Therefore, prior to surgery, patients should be appropriately informed of the potential for recurrence of the condition. Endoscopic urethrotomy is preferred because of faster healing, minimal scarring and less risk of infection, but the stricture is more likely to recur. In at least half of the patients, the disease recurs within two years after the operation.
It is recommended that you do not neglect your regular health checks for early diagnosis and treatment.
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