Urinary canal stenosis, which can occur due to infection or impact, is a condition that makes patients very aggrieved. The disease, which manifests itself with symptoms such as difficulty urinating or pain, can be easily treated with different methods.
What is Urinary Canal Stenosis and What Are Its Symptoms?
The urethra, which is the outer connection of the urinary bladder and the last part of the urinary canals, can be easily treated. If it is damaged for some reason, a scar tissue may form that reduces the width of the duct, and this may slow down the flow of urine and/or semen or in some cases completely prevent it. slowing
What are the Causes of Urinary Canal Stenosis?
The most common cause of these strictures in the urinary tract is past infections. In addition, interventions and surgeries such as catheter insertion through the urinary canal and blows taken from the outside can also cause scarring and thus narrowing in the urinary canal.
How to Diagnose Urinary Canal Stenosis?
The first diagnostic test in patients is uroflowmetry, which is a computerized measurement of urine flow rate. According to the result obtained in this examination, the patient can be directed to retrograde urethrography imaging. In this imaging method, the urinary canal is filled with an opaque contrast material under x-rays and the structure of the urinary canal is revealed under fluoroscopy.
1. Uretrotomy Intern: Known as "closed surgery" among the people, urethrotomy intern involves entering through the urethra with special devices with a camera and light source at the end, proceeding to the point of stenosis, and opening the stenosis with a cold knife under direct vision at this point. Since it is a painless and fairly simple procedure for the patient after the surgery, it is usually the first choice for minor urinary tract stenosis.
It was performed under general anesthesia or spinal anesthesia. This procedure takes between 20 minutes and 1 hour on average, depending on the type of stenosis. A urinary catheter is inserted during the operation and the patient is usually discharged on the same day. You will be given antibiotics and painkillers for you to use after the surgery. The urinary catheter is taken approximately 3 days later. It has been tried to keep the urinary catheter for up to 6 weeks in the hope of preventing recurrence of the stenosis, but it has been shown in scientific publications that keeping the catheter so long does not make a significant difference compared to staying 3 days. Although you can return to your work and life the following day, it would be appropriate to stay away from heavy sports and sexual intercourse for two weeks after the operation.
The success of urethrotomy intern operation is a controversial issue. Although 50-85% success is reported in short-term follow-ups in stenosis shorter than 1 cm, the success rate drops to 6-28% when patients are followed for a long time. Using laser instead of cold knife during urethrotomy intern does not make a significant difference in success. Considering the simplicity of the procedure, urethrotomy intern surgery is recommended as the first treatment option for all patients with stenosis shorter than 1 cm. If the stenosis recurs in the patient, since it is not possible to increase the success with the second urethrotomy intern attempt, other treatment options are discussed with the patient.
2. Urethral Dilatation: Urethral dilatation, which is based on regular enlargement of the urinary canal by a doctor or by the patient's self with a hard tube or bougie, was widely used for a period, especially to prevent recurrence of strictures after urethrotomy. Recent studies have shown that even if this application is applied twice a week and for 1 year, it cannot prevent the recurrence of stenosis and can only prolong the time until the stenosis develops.
Urethral dilatation is performed under outpatient conditions or at home with the help of special gels containing local anesthetics. The patient can return to his daily activities immediately after dilatation and does not need to use any medication. bees prefer. The point that should be known is that many of these interventions increase the hardness of the scar tissue, thus complicating future open surgical interventions and reducing their success.
3. Urethral Stents: Urethral stents are similar to cardiac stents in both appearance and function. The aim is to create a channel that will allow urine to pass, with an expandable cage structure placed inside the stenosis in the urinary canal. This procedure is generally effective in shorter and less deep strictures. It should be noted that these stenoses are also the most easily treatable strictures with internal urethrotomy and open surgery.
Stents are divided into two as removable and permanent.
Removable stents, the most popular of which is Memokath, are generally used to prevent strictures occurring in the early period after urethrotomy and to remove the stent when the healing process ends after 6 months to 1 year.
Permanent stents, the most popular of which is UroLume, are more often preferred in patients who have trouble getting anesthesia, who are elderly, and who are not candidates for open reconstructive surgery. In these patients, the stenosis is expanded with a stent and the stent is left permanently at the stenosis point.
Although stent application is usually performed under regional anesthesia, it can also be applied with local anesthesia supported by sedation. The procedure takes approximately 30 minutes and the patient is usually not placed in a urinary catheter after the procedure. The patient rests for a few hours after the operation and is discharged. The long-term success of this procedure, which usually does not develop complications during the operation, is surprisingly low. In ten-year follow-ups, satisfaction in stent patients is below 30%.
4. Open Surgery: Open surgery has a high success rate of 85%, which no other treatment method can offer. The aim of open surgery is to remove the part of the urinary canal that causes the stenosis and rejoin the intact ends. During this treatment, if the stenosis in the urinary canal is too long, the intact ends may be too far apart to be brought together. In such a case, closing the gap with a patch to be taken from another part of the body goes his way. While the most commonly used material for this is the "mucosa", the skin covering the inside of the mouth, different patch materials such as skin, tunica albuginea, tensor fascia lata can also be used.
Open surgery can be performed under general anesthesia or spinal anesthesia. The operation takes between 1 and 2.5 hours depending on the location and length of the stenosis. After the surgery, you are usually asked to stay in the hospital for one night. Painkillers and antibiotics will be given on discharge. The urinary catheter inserted during the surgery will be removed after 10 to 21 days, depending on the type of stricture repair. After about 4 days, you will be able to follow your daily routine with your catheter.
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