Narrowing of the urinary canal in women. Urethral stricture: symptoms

Which does not depend on any reason and leads to disruption of the normal outflow of urine from the bladder. We will talk about the symptoms and treatment of the disease further.

Symptoms of pathology

Symptoms of urethral stricture may include the following sensations:

• It is difficult to start urinating.
• Feeling of pain when urinating.
• Feeling incomplete emptying Bladder.
• Decreased urinary pressure.
• Presence of urine leaks.
• Spraying along with a bifurcated stream of urine.
• Development of hematuria - blood in the urine.
• Observation of blood in semen.
• Feeling of pain in the lower abdomen.
• The appearance of discharge from the urethra.
• Weakening of ejaculation - the release of seminal fluid from the urethra during sexual intercourse.

Forms of the disease

Based on the reasons for its appearance, congenital and acquired forms of this pathology are distinguished. The acquired type of urethral stricture occurs immediately after the birth of a person and can be traumatic, inflammatory or iatrogenic in nature, which, as a rule, occurs as a result of certain medical procedures.

In its course, the disease can be primary (occurring for the first time), recurrent (repeated appearance) or complicated.

Possible locations:

• Anterior urethra. In this case, part of the urethra is located in the penis.
• Posterior urethra, when the part is in close proximity to the bladder.

Based on its length, a urethral stricture can be short (up to one centimeter) or long (more than one centimeter).

Causes

Congenital urethral stricture is caused by defects received from birth, which are expressed in a narrowing of the urethra. Acquired forms of pathology are explained by several reasons. Most often this happens due to various injuries:

• Receiving blunt injuries in the perineal area due to a blow, fall, etc.
• Penetrating wounds in the form of stab wounds, gunshot wounds, and bites.
• As a result of sexual excesses - the presence foreign bodies in the urethra along with fractures of the penis, which can in turn be accompanied by severe pain, and, in addition, profuse internal bleeding.
• Fracture of the pelvic bones due to car injuries, falls from a height, and so on.
• Chemical and thermal nature of damage to the urethra through substances used for treatment.

In addition, this pathology can occur due to the presence of inflammatory processes in the urethra, that is, with urethritis. Post-radiation urethral strictures in men and women, which arise as complications after radiation treatment, aimed at the use of radiation for the treatment of tumor neoplasms, also causes the appearance of this pathology. Other provoking factors include the following reasons:

• The presence of iatrogenic causes, which are caused by careless performance of urological manipulation and surgery.
• The presence of concomitant abnormalities in diseases that are accompanied by deterioration of metabolism and blood supply to the tissues of the urethra, we're talking about about diabetes mellitus, arterial hypertension and coronary heart disease.

Diagnosis of the disease: history taking

As part of diagnostic measures in order to determine subsequent treatment, patients are prescribed the following tests and procedures:

• Collecting an anamnesis of the disease, as well as complaints regarding the appearance of the first symptoms, its development, and so on.
• Conducting a life history analysis. In this case, risk factors for the disease are identified. In particular, the emergence of infectious pathologies of the genitourinary system along with their frequency is analyzed; various injuries in the perineal area, fractures pelvic bones and so on.
• Getting examined by a urologist.
• Holding a finger rectal examination prostate gland. As part of this diagnostic method, a forefinger, after which the prostate is palpated. This technique makes it possible to assess in detail the size along with the general pain and shape of the organ.

Laboratory research

Among other things, urological specialists for urethral stricture in men conduct laboratory tests of smears that are taken from the urethra in order to determine the presence of certain sexually transmitted infections. This is done through the following methods:

Alternative diagnostic methods

In addition to the above methods, the following options for diagnosing urethral stricture are carried out:

• Taking a general urine test, which makes it possible to detect excessive levels of protein along with leukocytes, red blood cells and pus.
• Conducting uroflowmetry, in which the speed of urine flow is measured using a special device, which makes it possible to assess the severity of urination disorders.
• Carrying out an ultrasound examination of the bladder. This procedure is usually performed immediately after urination, which makes it possible to determine the level of residual urine, getting an idea of ​​​​the violations of various functions.
• Carrying out an ultrasound examination of the kidneys, which allows you to obtain an image of the organ to assess the presence of certain changes.

X-ray contrast methods for diagnosing the disease

This method allows you to evaluate the localization along with the extent of the urethral stricture (ICD N 35), determining the presence of false passages, diverticula, and, in addition, the presence of stones, including in the bladder. In this case, the technique is as follows:

Endoscopic diagnostic methods

This type of diagnosis allows you to examine the area of ​​urethral stricture, making it possible to establish possible reasons diseases and perform a tissue biopsy for subsequent research. This method involves following procedures:

• Cystoscopy, which examines the bladder using a special instrument. This instrument is a cystoscope, which has a built-in metal casing. optical system.
• Urethroscopy, which is the examination and examination of the urethra, is also done using this instrument.

How is urethral stricture in men treated?

Treatment

The following treatment options are used to treat this disease:

Various surgical lasers are used in the endoscopic treatment of strictures.

The most commonly used laser is neodymium. It has a simple and compact design, good radiation power.

Internal laser urethrotomy is performed according to the classical method of optical urethrotomy, when a laser beam dissects the scar ring around the circumference of the stricture in one place. There should be no deep penetration of the optical fiber into scar tissue, as this may cause coagulation of healthy tissue.

Strictures greater than 1 cm in length are treated with a technique in which coagulation of scar tissue is performed in several places.

Possible complications and consequences

Against the backdrop of development of this disease The patient may be at risk for the following complications:

Complications after urethral stricture surgery include the following:

• Development of relapse - reappearance of pathology and development of bleeding.
• The process of extravasation, against the background of which the surrounding tissues are saturated with blood.
• Enlargement of the penis with a sharp increase in elasticity, which will subsequently contribute to the replacement of spongy tissue with connective tissue.
• Displacement of the installed stent, which will cause severe pain during sexual intercourse and while sitting.

Prevention of pathology

In order to carry out prevention, it is necessary to monitor the risk of acquiring sexually transmitted diseases. In this regard, it is necessary to refuse random connections, and, in addition, use barrier methods of contraception. To prevent this from happening unpleasant disease It is equally important to observe the rules of personal hygiene during intimate life. As part of this recommendation, regular genital hygiene should be performed immediately after sexual intercourse. Only a personal towel should be used. Undergoing a preventive examination by a urologist along with examination for venereal diseases must be performed by men at least once a year.

It is extremely important to carry out timely treatment urethritis if its symptoms appear in men. A urethral stricture will then not occur. Physicians must exercise caution during endourethral procedures. In addition, men should avoid injuries and other unfavorable factors, such as hypothermia.

Urethral stricture, or narrowing of the urethra, is one of the common urological diseases. According to statistics, up to 1% of the male population suffers from urethral stricture. In women, urethral stricture is much less common and can be a complication of injuries, some operations and radiation therapy oncological diseases.

In large cities, every year, as a result of car accidents or work-related injuries alone, more than 150 people receive pelvic fractures, which are accompanied by the development of urethral stricture and, of course, require surgical treatment.

In addition to injuries, common reasons the occurrence of urethral strictures are medical interventions on the urethra, such as transurethral resection, various methods of endoscopic stone removal urinary system, minimally invasive therapeutic interventions for prostate tumors (HIFU, brachytherapy, etc.).

Even a traumatic installation urethral catheter or its prolonged presence in the urethra can lead to the development of urethral stricture, especially in patients suffering from coronary disease hearts.

Other common causes of urethral strictures include inflammatory diseases urethra, among which today lichen sclerosus (Lichen Sclerosus, Balanitis xerotica obliterans) predominates.

Gonorrhea and other sexually transmitted infections and associated urethritis complicated by urethral stricture are rare today. They are usually treated well and promptly with antibiotics. Thus, urethral stricture is the second most common cause of difficulty urinating in men, after prostate adenoma.

Urethral stricture: symptoms

Urethral stricture is manifested by a weakening of the urine stream, a feeling of incomplete emptying of the bladder and difficulty urinating.

Sometimes it is completely impossible to empty the bladder, and urinary retention develops. In this case, trying to remove urine using a catheter is risky; you can damage the urethra, which will complicate the course of stricture disease.

If the patient knows about the existence of a urethral stricture, if urination is delayed, it is necessary to consult a urologist who will install a special drainage in the bladder - an epicystostomy, through which urine will be released before surgery to restore urethral patency.

Urethral stricture: diagnosis

An examination for urethral stricture begins with a detailed conversation with the patient, analysis of his complaints and history of the development of the disease. The specific part of the examination includes several procedures.

These include:

1. Determination of urine flow rate, or uroflowmetry. Below in Fig. 1 you see a typical picture of the urinary flow rate curve in a patient with urethral stricture. It is called a “flat curve”. Fine maximum speed urine flow (Qmax) should be above 15 ml/sec. In the picture shown, Qmax = 5.1 ml/sec. When Qmax ≤ 5 ml/sec, the probability of complete cessation of urination within the next month exceeds 50%.

2. X-ray examination urethra, or urethrography. Its essence lies in the fact that an X-ray contrast agent is injected into the urethra, which makes it possible to determine the very fact of the presence of a urethral stricture, its location in a certain part of the male urethra (pendulous or penile, bulbous, membranous, prostatic), the extent or length of the stricture. In Fig. Figure 2 shows a urethrogram of a short stricture of the bulbous urethra (indicated by an arrow).

The occurrence of such strictures may be associated with blunt trauma to the perineum (blow, fall), insertion of various instruments into the urethra (urethrocystoscope, catheter, etc.), less often as a consequence of infections, such as gonorrhea.

Such strictures usually arise as a result of traumatic instrumental manipulations of the urethra (urethroscopy, cystoscopy, catheterization), chemical burns urethra (administration of antiseptic solutions of inappropriate concentrations), as well as as a result of inflammatory processes such as lichen sclerosus.

3. Quite often, visual assessment of the stricture and the urethra as a whole requires an optical examination of the urethra and bladder or urethrocystoscopy. This procedure is usually performed using a flexible optical instrument, a urethrocystoscope, and correct execution practically does not cause discomfort. In Fig. Figure 4 shows an image of a urethral stricture obtained during urethrocystoscopy. Information obtained from urethrocystoscopy allows you to better plan surgical treatment and determine its type and extent.

To diagnose the degree of damage to the corpus spongiosum surrounding the urethra and the blood supply to it (the degree of spongiofibrosis), research methods such as magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography(ultrasound) of the urethra. These diagnostic methods are of an auxiliary nature, but sometimes they make it possible to predict the effectiveness of a particular method of surgical treatment.

Why is it important to get rid of urethral stricture?

If urination occurs with difficulty and the outflow of urine is disrupted, then an infection begins to multiply in the urinary system, as a result of which, first of all, the kidneys suffer.

The most serious complication of urethral stricture is renal failure, that is, the inability of the kidneys to work, which can threaten the patient’s life.

Urethral stricture can lead to the formation of urinary stones and contribute to the deterioration of bladder function. At severe course stricture disease of the urethra, the latter completely loses its patency and independent urination becomes impossible.

If the patency of the urethra is not restored, urine excretion in such a situation can only be carried out through a catheter installed in the bladder through a puncture in the lower abdomen (epicystostomy). It must be remembered that a person has one urethra. If it tapers, then no. paired organ who could replace him. A dysfunctional urethra represents big problem for the functions of the entire urinary system.

How is urethral stricture treated?

If a urethral stricture is identified, then its treatment should be carried out by an experienced specialist who knows the entire modern arsenal of methods for treating urethral stricture, since often the final choice of the most effective technique occurs directly during the operation.

A modern reconstructive urologist surgeon must receive appropriate education and training in leading centers for reconstructive urology from renowned specialists. It must constantly improve its skills and participate in international congresses and symposiums on this topic.

Most importantly, he must have sufficient practical experience to maintain his surgical skills and, according to the general opinion of experts in the field of reconstructive urology, perform at least 30–40 reconstructive plastic surgeries on the urethra per year.

As a rule, no more than 5% of urologists, even in the most developed countries of the world, fully meet these requirements. After the examination, qualified specialist, based on its results, will offer the patient optimal method surgical treatment.

For short, no more than 1 - 1.5 cm long strictures of the bulbous urethra, the method of choice is endoscopic surgery, which is called internal optical urethrotomy (IOU). The essence of this operation is that the site of narrowing of the urethra is dissected under eye control using an endoscopic urethrotome knife. Thus, the lumen of the urethra increases and urination is restored. It is important to note that the effectiveness of the first urethrotomy can reach 60-70%, provided that it is performed according to indications. A second urethrotomy for recurrent urethral stricture will be effective in no more than 20-30% of cases. The third is almost never effective.

If the urethral stricture is located in the hanging (penile) or membranous parts of the urethra, and also has a greater length than 1 - 1.5 cm, the patient will be shown reconstructive surgery for urethral stricture plastic surgery, which can be performed using several methods. For strictures of the bulbous and membranous urethra, anastomotic plastic techniques are widely used (according to Holtsov, according to Webster), when the affected narrowed section of the urethra is completely excised, and the healthy and unchanged edges of the urethra are sutured together. The effectiveness of such operations in experienced hands exceeds 90%.

When the urethral stricture is located in the hanging (penile) section, as well as when the length of the stricture is more than 3-4 cm, so-called augmentation urethroplasty operations are performed, when the lumen of the urethra is expanded by inserting healthy tissue from other parts of the body into it. Such tissues can be the mucous membrane of the oral cavity (cheek, tongue) in the form of a free patch or the skin of the foreskin of the penis in the form of also a free patch or a blood-supplied flap on a pedicle.

During such operations, the lumen of the urethra is incised and displaced tissue is inserted into the incision area, which leads to the expansion of the urethra to normal sizes. The effectiveness of augmentation urethroplasty is in the range of 75 – 85%.

In case of complete closure (obliteration) of the lumen of the urethra when the stricture is located in the hanging (penile) section or when the length of the obliteration zone is more than 3-4 cm, methods are used to completely replace the urethra with a newly created one from other tissues (usually the oral mucosa). Such operations are performed in at least 2 stages. At the first stage, the affected segment of the urethra is completely excised and a flap of the oral mucosa is implanted in its place, which takes root on well-supplied tissues. After a minimum of 6 months, the second stage of the operation is performed - the formation of a urethral tube. If after the 1st stage the oral mucosa has not healed well, it is performed again. The effectiveness of these urethroplasty techniques varies from 65 to 85%.

What determines the effectiveness of treatment for urethral stricture?

The effectiveness of surgical treatment of urethral stricture certainly depends primarily on the qualifications of the operating specialist. An important factor is the presence of a well-equipped operating room (high-quality operating table, special footrests, head light, and much more). It is important to have at your disposal a full range of necessary surgical instruments, suture materials, special catheters and much more. If you have a urethral stricture, we recommend that you immediately take a responsible approach to choosing a clinic and an operating surgeon, because the first operation is the most effective. Repeated operations much more difficult and have a lower success rate.

At the EMC Urology Clinic, doctor of medical sciences, associate professor Alexey Zhivov, an internationally renowned specialist, treats urethral stricture expert level in the treatment of urethral strictures. Dr. Zhivov's surgical experience in the field of reconstruction of urethral strictures is one of the most extensive not only in Russia, but also in the world. Dr. Zhivov is a member of the prestigious international associations of reconstructive urological surgeons GURS and ESGURS, and gives lectures and practical master classes at major Russian and international symposiums dedicated to the problem of urethral stricture.

The EMC Urological Clinic has everything necessary equipment for reconstructive operations on the urethra and other organs of the genitourinary system. The operating room has the best operating tables, purified air supply systems and sterilization of surgical instruments ensure the absence of bacterial agents in the operation area. Comfortable hospital rooms are equipped with everything necessary for the convenience of our patients. Well, nursing and medical care for postoperative patients at EMC is at the level of the best hospitals in the world. We responsibly declare that the treatment of urethral stricture at the EMC Urology Clinic meets the most modern standards and our patients do not need to travel abroad for treatment of urethral stricture.

Urethral stricture refers to a change in the shape of the canal associated with its narrowing and deterioration of patency. Men are more susceptible to the disease than women. This is due to the structural features and increased injury rate.

The narrowing of the channel is pathological disorder, so it’s impossible to get rid of it on your own. At the site of the stricture, not an ordinary scar appears, but a layer of cells. In the process, fibrous tissue is formed from the spongy layer, which interferes with urination and blood circulation.

If left untreated, stricture can be a precursor to the following pathologies:

• chronic pathologies all urinary system infectious and non-infectious:
• prostatitis acute and chronic;
• inflammation of the testicles and their appendages;
• diverticula (blind protrusions of the walls of the urethra and bladder);
• hydronephrosis due to impaired urine outflow and kidney failure.

To avoid serious pathologies and complications, the stricture must be diagnosed and treated in time:

1. Pathology has its own code in the international classification of diseases (No. 35).
2. Post-traumatic (No. 35.0).
3. Post-infectious stricture, which is not classified in ICD 10 under other headings (No. 35.1).
4. Another type of urethral stricture (No. 35.8).
5. Unspecified urethral stricture (No. 35.9).

The development of urethral stricture has several stages. Depends on them further treatment and deterioration of the patient's condition:

• changes in the urothelium, damage to the mucosa;
• urinary leaks with a layer of infection;
• pathological growth and healing of tissues;
• the beginning of cicatricial and sclerotic processes.

Causes

There are direct and indirect factors that lead to a narrowing of the urethral canal or a change in its shape in individual segments:

1. valve narrowing urinary canal(occurs in congenital abnormalities in no more than 2%);
2. injuries (70%);
3. inflammatory processes in the urethra (15-20%);
4. medical intervention (10-13%).

Acquired strictures are the most common in urological practice.

What causes post-traumatic strictures:

• blunt trauma to the genital organ;
• penetrating wounds of the urinary canal;
• vigorous sex life;
• foreign bodies in the urethra (with urolithiasis);
• penile fractures;
• fractures of the pelvic bones (due to car injuries, falls from high objects);
• damage to the urethra by chemicals and heat.

Medical or iatrogenic causes:

• urethroscopy;
• cystoscopy;
• bougienage;
• catheterization;
• removal of stones from the canal;
• transurethral resection of the prostate;
• complete removal of the prostate;
• penile prosthetics;
• radiotherapy with the introduction of a radiator into the urethral canal.

Other development factors:

• previous infectious urethritis due to sexually transmitted diseases;
• tuberculosis;
• inflammation of the glans penis (balanitis);
• nonspecific degenerative process in the penis;
• deterioration of blood supply and metabolism in the tissues of the urethra.

Kinds

There are several types of strictures, they differ in locality and location of the process:

1. Short (up to 2.5 cm in length).
2. Extended (more than 2 cm).
3. Strictures of the anterior urethra (external entrance, capitate, penile).
4. Strictures of the posterior urethra (membranous, prostatic).
5. Subtotal (damage to 2⁄3 of the urethral canal).
6. Total (almost the entire urethra or canal along its entire length is involved).

Strictures of the pyelourethral segment

The pathology involves the urethral canal bordering the ureter and pelvis. A segment in this system plays an important dynamic role; when it is damaged, serious problems with urination. If a patient has urolithiasis, then quite often small stones are found in this compartment. They can cause attacks of pain and renal colic simultaneously.

Membranous segment stricture

The membranous section is located in the distal area, the most distant from the external entrance to the canal. There is a bend here leading forward and upward. The structures in this area are difficult to access due to anatomical structure. The elements of the urethral sphincter are also located here. If they are damaged, the patient may experience complete disruption of urination.

Symptoms

Typically, a stricture occurs after trauma or other exposure. It is important to differentiate it from prostate adenoma or hyperplasia.

What signs exist:

• thinning urine stream, decreased pressure;
• volume total quantities urine output per day decreases significantly;
• feeling of an unemptied bladder after going to the toilet;
• prolonged process of urination or before it;
• if you want to urinate, you need to tense your stomach;
• a stream of urine sprays;
• discharge of urine from the urethra after urination;
• pain and discomfort when emptying the bladder;
• spreading pain to the lower abdomen;
• discharge from the urethral canal during congestion and infection.

It is impossible to make a diagnosis based on symptoms alone. Without additional examination it may be wrong. Sometimes hematuria joins the symptoms if the canal is damaged by a stone from the ureter. With severe stricture, urine is released drop by drop or is completely blocked. Such a violation requires immediate treatment by a urologist.

Diagnostics

During the examination, it is important for a specialist to find out the reason for the development of the stricture. He carefully reviews the symptoms and history. If you suspect inflammatory process the patient will need to undergo smears for possible infections genital tract.

What tests are prescribed:

• papillomavirus and immunofluorescence;
• PCR (polymerase chain reaction);
• bacteriological culture;
• general blood and urine tests (leukocyte and erythrocyte levels).

Types of research:

• cystometry (examination of the bladder to determine its filling);
• profilometry (measurement of lumen pressure in all parts of the urethra);
• Ultrasound after urination (detects the level of urine remaining in the bladder);
• x-ray (determining the extent of stricture, false passages, protrusion and stones);
• urethroscopy (identification of the causes of pathology, tissue sampling for histological examination).

For a complete picture, the doctor may require a urination chart for the last three days. Everything is recorded in a special diary (total volume, intensity of pain during urge, amount of urine leaked after going to the toilet and liquid consumed).

Treatment

Thanks to modern constructive surgery techniques, any form of stricture can be corrected. There is no single therapy for the treatment of this pathology:

• Bougienage

The widely used treatment for stricture is lifelong. When the expansion of the canal stops, the signs of pathology are restored, and the disease progresses. The initial stage of the operation is associated with difficulties. Canal restoration must be repeated and bloodless. If blood appears during the procedure, this indicates a new rupture of the mucous membrane in the canal, which is very unfavorable for the course of the pathology.

Indications for bougienage are short strictures, long disorders with uniform narrowing, absence of infection and low risk of mucosal damage. Bougienage is suitable for patients who cannot undergo surgery with resection and plastic surgery.

• Internal optical urethrotomy

It involves cutting the urethra with a special instrument. The operation has the same effect as bougienage. About half of men suffer from relapses after urethrotomy, so it is important for them to carry out bougienage for 6 months. Symptoms may worsen over the course of two years. The operation is performed for short strictures after trauma.

Urethrotomy is not performed on penile strictures if they are equal to or exceed 1 cm. With deep formation of fibrous tissue, relapse of the pathology occurs after 2-3 months.

• Laser cutting of stricture

During the operation, the specialist achieves dilation of the urethra by evaporating fibrous tissue from laser beam. The patient has a catheter in place for 3-5 days. In some cases, relapses of the disease occur, so lifelong monitoring of the urine stream will be required. Statistics show late relapses 5-10 years after laser treatment.

• Stenting

The technique is based on the introduction of a special frame (stent) into the lumen of the canal, which is opened using a capsule inside. The treatment is effective, but is not used for severe periurethral fibrosis. Probability of overgrowth connective tissue in the stent reaches 40%. Deep disturbances will provoke stagnation of urine and pain inside the canal.

• Resection of the urethral canal

It is used for strictures larger than 2 cm, when the bulbous section is affected. Affecting the penile region can lead to shortening of the penis or a decrease in the angle associated with the axis of the organ and abdominal wall. Resection is indispensable for deep lesions. On this moment In surgery, complex plastic techniques are performed that prevent maximum changes in the penis. The effectiveness of resection is more than 90% within 10 years.

• Replacement urethroplasty

The most complex and effective operation for deep lesions of the urethra. It is used for particularly long strictures of the bulbous, penile and capitate sections. The technique includes several stages with longitudinal urethrotomy and patch plasty.

Forecasts

In most cases, treatment of strictures ends successfully, and the patient’s condition does not change for a long time or for life. With palliative treatment, the patient’s ability to work is not impaired.

After open plastic surgery, the patient can remain in the hospital under observation for up to 14 days. Temporary disability lasts up to 20 days. Suture care is eliminated if absorbable material is used to treat strictures.

Lifelong monitoring is important for the patient to control relapses. The most dangerous period After surgery, 2-5 years are considered. It is necessary to monitor the health of the genitourinary system and prevent infectious diseases.

In some cases, after surgery, side effects may occur due to relapse:

• decreased sex drive;
• psychological and emotional disorders;
• weight gain;
• vegetative-vascular symptoms;
• metabolic disorder.

To prevent narrowing and defects, it is necessary to monitor your health and reduce risk situations that lead to damage to the urethra.

You can also watch this video, which will explain in detail how dangerous urethral stricture is.

Urethral stricture – pathological disease, in which the urethra narrows. This occurs because the normal mucous membrane and the surrounding spongy tissue of the corpus spongiosum of the urethra are replaced by scar tissue.

This pathology ranks second among the causes that interfere with urinary emptying. The first place here is given to adenoma and hyperplasia. There are several forms of this disease, they are graded according to severity (from slight difficulty in urination to its absolute impossibility). In addition, urethral stricture can be congenital (this type of disease is extremely rare) or acquired.

The structure of the male urethra

The symptoms that appear with urethral stricture may indicate the presence of other serious pathologies and diseases. Especially if it appears after 40 years. A stricture manifests itself as follows:

1. weak urine stream
2. decreased amount of urine when urinating
3. feeling that the bladder is full even after urinating
4. waiting a long time before urination begins
5. abdominal tension to urinate
6. pain, discomfort while going to the toilet
7. bleeding
8. abdominal pain

Often, after contacting a specialist with the above complaints, patients are given an incorrect diagnosis due to insufficient examination. To rule this out, contact only those doctors who specialize in the treatment of urethral stricture.

Causes

Most often, the cause lies in damage to the urethra itself. They can be traumatic, chemical, radiation, infectious-inflammatory and thermal. In this regard, the following main causes of stricture can be identified:

• injury to organs located in the pelvis
• diseases of infectious origin
• malignant formations
• errors when instrumental research, after which wounds form and scar
• irradiation
• skin inflammation

Urethral stricture

Treatment

The main methods of treating urethral stricture are:

1. Bougienage
2. Optical urethrotomy
3. Stenting
4. Surgical reconstruction
5. Laser treatment

The first two methods appeared a long time ago, and have been effectively used in the treatment of strictures for many years.

When bougienage occurs, stretching, spreading, and sometimes tearing a narrow section of the channel through which urination occurs. This is done with a metal rod that has a smooth surface and different diameters. However, despite all the advantages of this method, it is not capable of providing a complete cure. The urethra enlarges only for a while, but the main causes of stricture - impaired blood supply to the narrowed zone - are not eliminated. Very often, after bougienage, the disease recurs; moreover, the stricture becomes rougher and more prolonged. The more often bougienage is done, the more it harms the patient’s health.

Urethrotomy is also not able to completely eliminate the disease. And this despite the fact that in last years the procedure is performed using a cystoscope. During the procedure, the doctor dissects the narrowed section of the urethra. Otherwise, urethrotomy is similar to bougienage and differs from it only in that the relapse rate is slightly lower.

In view of the above, urethrotomy and bougienage are prescribed to the patient only if the urethral stricture is not too large (up to half a centimeter). In other cases, these methods act only as treatment aids.

If the patient’s disease recurs after urethrotomy or bougienage, it is strictly contraindicated to use these methods again.

A urethral stent (or a special spring) keeps the narrow part of the urethra dilated. The only “minus” of this method is that the stent can migrate and become dislodged, and this can lead to serious complications. This is why stenting is rarely used.

One of modern methods treatment of urethral stricture is Plastic surgery. It is used if the lesion is more than 1 cm. The operation of urethral stricture consists of replacing the urethra, which is affected by the stricture with healthy tissue. The effectiveness of this operation is more than 80%. Plastic surgery helps to cure even those patients in whom almost the entire urethra is affected by stricture

Treatment of urethral stricture with laser is a short-term surgical intervention that is considered the most favorable method. Before the operation, the patient must undergo an optical examination of the urethra.

Chronic urethral stricture

If the disease has taken chronic course, treatment always involves surgery. The fact is that untreated stricture can lead to serious complications in the future. The process of urination gradually becomes more difficult, and opening the neck of the bladder becomes difficult. All this can lead to anuria, as a result of which the urologist may decide on catheterization or other drastic measures.

Diagnostics

When a patient contacts a urologist with severe symptoms, the doctor must first find out the true causes of urethral stricture.

Bougienage of the urethra

If an inflammatory stricture is suspected, laboratory tests are required: a smear is taken to check for sexually transmitted infections, PCR diagnostics and bacterial culture are performed.

It is impossible to make a diagnosis without uroflowmetry, cystometry, profilometry, and video-urodynamic examination.

Ultrasound of the bladder helps determine the volume of residual urine. It is recommended to do it immediately after bowel movement. This research method helps to judge the degrees of functional decompensation.

Endoscopic diagnostic methods make it possible to examine and thoroughly study areas of strictures, find out the causes of the disease, and conduct a biopsy for morphological research.

Treatment with folk remedies

It is also possible to treat urethral stricture folk remedies. IN folk medicine For these purposes, various herbal infusions and decoctions. For example, black currant. For a day you will need a decoction of 3 tablespoons of blackcurrant leaves poured with a glass of boiling water. For acute inflammation, decoctions of currant berries are excellent - they are used as diuretics and anti-inflammatory agents.

In some cases, they cope well with urethral strictures leeches. They are applied along the skin lines with a projection onto the ureter. Sessions last 6-8 hours. The interval between sessions is about three days. This treatment relieves inflammation, restores and stimulates the functioning of the ureters.

Principle of urethroplasty

An excellent anti-inflammatory agent with diuretic and antimicrobial effect have juniper, black poplar, chamomile, lingonberry, black elderberry.

An excellent remedy for strictures - herbal tea , a decoction of which should be taken every hour an hour before meals, half a glass. Prepare for this. Mix birch leaves, flaxseed, licorice root, bearberry leaves. It's equal in total. To prepare the decoction you will need 10 g this fee. When you measure it, add 300 ml of boiling water and simmer in a water bath for about 10 minutes. Then pour the finished broth into a thermos and leave to steep for a couple of hours.

Another collection is also no less useful, but it is prepared a little differently. The mixed ingredients (equal parts: juniper, parsley root, hernia, yarrow) should be crushed to a powder. Then measure out 10 g of powder and pour a glass of boiling water, boil for another five minutes and leave for a couple of hours. After this, the broth should be filtered and taken half a glass 4 times after meals.

Decoction lingonberry leaves, flaxseeds, calendula flowers, violets, lovage, take half a glass three times a day before meals. First, mix the ingredients in equal parts, measure out 10 g of the mixture, then pour 300 ml of boiling water and simmer in a water bath for 10 minutes. Leave in a thermos for two hours, then strain and take as described above.

Has an excellent effect decoction from the following herbs: cornflower flowers, wintergreen leaves, angelica root, cinquefoil and nettle herbs are mixed in equal quantities and crushed. You will only need 8 g of this powder. Fill it with a glass of boiling water and leave it in a thermos for at least 4 hours. Then we filter and drink half a glass three times a day, half an hour before meals.

Preventive measures

First of all, prevention of urethral stricture is aimed at eliminating unfavorable factors that provoke narrowing or damage to the urinary canal.

In order to protect yourself from stricture, be sure to use condoms during sexual intercourse!

Gonococci and chlamydia are infections that can primarily provoke the development of the disease. You can become infected with them during casual sex.

Do not allow medications or other agents that may cause burns to the mucous membranes to enter the urethra. Any inflammation of the urethra should be treated immediately. At the first sign of infection or inflammation, be sure to seek medical help.

2

Make an appointment with a doctor right now and don’t put off the problem for later.

Often there are problems with urination, which are associated with various diseases or injuries to the urinary system. Urethral stenosis or stricture is a common disease in which the opening of the urinary canal narrows. The pathology is characterized by urinary disorders with various accompanying manifestations. With urethral stricture, urine excretion becomes difficult and splashing is observed. Pathology requires timely diagnosis and proper treatment.

General information

Narrowing of the urinary canal is a serious abnormality in urology and requires proper treatment. As a result of narrowing of the urethral opening, the excretion of urine is impaired, which entails dangerous consequences, including kidney failure. The development of deviations is caused by scars that have arisen for various reasons in the place where there should be a healthy mucous membrane. When strictures occur in men and women, various symptoms, which depend on the degree and nature of the pathology.

Varieties

Depending on the nature of origin, congenital and acquired strictures are distinguished. Deviation is classified according to etiological factor for traumatic, inflammatory, congenital and idiopathic stenosis. The latter is said when the cause of the disease cannot be identified. Considering the nature of the deviation, primary, recurrent and complicated deviations are distinguished. There are several types based on the location of the pathology: prostatic, membranous (on the posterior wall of the urethra), bulbar, penile and capitate stricture.

Stages of development

The pathological process, which is acquired in nature, occurs in 3 stages:

• On initial stage Damage to the urothelium is noted.
• The second stage is characterized by the formation of urinary leaks, which leads to secondary infection.
• On last stage Scar tissue granulates and grows. Over time, a person experiences a scar-sclerotic process, in which the mucosal tissue is largely replaced by scar tissue.

Features of urethral stricture in men

Urethral stricture is diagnosed twice as often in men as in women. This is due to the structural features of the genitourinary system. The narrowing of the urethra in men is caused by various reasons, which provoke blockage and problematic excretion of urine. In case of defeat in the male genitourinary system gets injured epithelial tissue back wall, the structure of the spongy body is disrupted. More severe forms of the disease affect the condition of the paraurethral tissues. The scar that appears at the site of the mucous membrane narrows the lumen of the urethra.

The male urinary tract consists of the following main segments:

• membranous or membranous area;
• prostatic or prostate region;
• spongy or spongy.

All parts of the urethra have a special structure and consist of various tissues that have their own characteristics. Therefore, if a different segment is damaged, it will be noted various symptoms. Stricture of the prostatic urethra is most often diagnosed.

Features in women

The female body suffers from urethral strictures, but much less frequently than the male body. This is due to the structural feature of the urethra, which is much shorter. Often the deviation is diagnosed in girls who have undergone surgery for gynecological reasons, which resulted in pinching and the formation of scar tissue.

The narrowing can occur in any part of the organ and in most cases a large area of ​​the urethra is affected. For women, the formation of urethral strictures is extremely dangerous because it causes bladder overflow. As a result, there is strong pressure on internal organs, which are located nearby, which disturbs them normal work and leads to displacement.

Pathology in a child

Urethral stenosis in children is most often caused by congenital anomaly, which provoked an abnormal structure of the urethra. Mostly, narrowing of the urethra in a child is observed in the lower part of the head of the genital organ or in the scrotum area. If at birth there were no congenital abnormalities in the genitourinary system, then the stricture is caused by injuries that damaged the structure of the urethra.

In girls, an anomaly due to trauma is rarely diagnosed; as a rule, the deviation occurs due to the mobility and elasticity of the urinary canal.

Main reasons

Often, stricture is a pathology that occurs independently and is characterized by various symptoms. Often the deviation occurs after a tour of prostate adenoma or other surgical operations on the organs of the urinary system. Often a stricture occurs after surgery due to gynecological problems. The following are the main causes of stricture in the urethra:

• injury or injury to the perineum or genital area;
• fractures of the pelvic bones;
• long-term use of a urethral catheter;
• infections in the genitourinary system;
• influence chemical substances on the urethra;
• difficult childbirth;
• venereal diseases.

Symptoms of the disease

With urethral strictures, symptoms appear quickly enough and have a pronounced pronounced signs. First of all, the patient complains of problems with urine excretion. This is due to the fact that the lumen narrows and does not allow urine to come out fully. Over time, the following signs appear:

• pain in the pelvic region;
• bloody discharge when urinating;
• in men there is blood in semen;
• excretion of urine in a thin stream;
• painful urination;
• feeling of a full bladder;
• reducing the amount of urine.

In severe cases, urine is excreted in a few drops or the process of urination stops altogether due to blockage of the lumen. When the above signs, you should apply for medical care, since complications of urethral stricture are extremely dangerous and threaten irreparable consequences.

Diagnostics

To identify a urethral stricture, you should undergo appropriate tests and undergo diagnostics using various instrumental methods. The patient is prescribed the following laboratory tests:

• urethral smear to determine infections;
• PCR diagnostics;
• bacteriological culture;
• general urine analysis;
• bacterial culture of urine.

Using, doctors are able to find out at what speed urine moves through the urethra.

Important diagnostic procedures are cystometry, videourodynamic examination and profilometry. Effective way research serves ultrasound diagnostics pelvic organs and bladder. The procedure is carried out immediately after the bladder has emptied so that you can see how much urine remains. Often, the patient is prescribed x-rays and urethrography, with the help of which they determine whether there is diverticulosis or stones. Additionally, endoscopic diagnostics are carried out in order to study the damaged area of ​​the urethra as much as possible and find out the causes of the deviation.