The urethra is the tube that conveys urine from the bladder, where it is stored, to the outside. In the male it is much longer and passes through the prostate gland, with a curve morphology. The woman is a shorter and accessible through. Obstructive problems of the urethra, called urethral stricture, very often confused with obstructive prostate growth, far more frequent in relation to the natural aging human condition.
However, proper differentiation of the two processes is critical because treatment is completely different.
The abnormal positioning of the end of the urethra (generally, Hypospadias), meatus or place by which urine comes out, is a common congenital anomaly in the newborn must also be corrected surgically child.
What is urethral stricture?
This is a narrowing of the duct of the urethra which causes difficulty urinating or, at least, to completely empty the bladder, which in the long run cause urinary tract infections, incontinence or loss, loose and staccato stream, urgency and increased urinary frequency.
As time passes the situation may worsen and cause the destruction of the bladder muscle after years of working at high pressure, which can cause inability to urinate (chronic urinary retention), promotion of urine into the ureters or kidneys from the bladder and irreversible kidney failure, the patient still having the feeling of being perfectly urination and comfortably.
The cause urethral strictures can be congenital (birth), traumatic, infectious, by manipulation of the lower urinary tract (probes, transurethral surgery ...), inflammatory and even unknown. Special mention should Balanitis xerotica obliterans (BXO), autoimmune condition probable cause and that at the beginning is confused with phimosis or narrowing of the foreskin and just shaking the whole urethra.
Urethral strictures are not exclusive to the male, contrary to what some physicians consider because of their different anatomy, and this causes many women are undiagnosed and untreated.
What treatment requires urethral stricture?
Urethral stricture is always surgical treatment. In selected cases, congenital cause short length without fibrosis, you can try an endoscopic urethrotomy, minimally invasive and easy to perform but with a success rate of, at most, 40% in these favorable cases.
In others, treatment is open surgery. Depending on the cause, the location of the same and their appearance, can choose to perform excision of narrow urethral segment and end- to -end anastomosis (cutting the infected area and rejoining the ends), not recommended if the length is greater 1-1.5 cm to avoid curvatures of the erect penis, or choose to increase or urethroplasties substitution skin flaps or free flaps.
Unless it is possible to perform end to end uretroplasty, we opted for grafts oral mucosa (inside the patient's mouth), with excellent tolerance, the patient is eating the next day, and a very good viability of mucosa in the urethral bed.
For this requiring replacement of the diseased urethra (for example, in a BXO), we do surgery in two steps: first we remove the diseased urethra and place the graft buccal mucosa at the site, and 4- 6 months intervenes again to close the new patient urethra and into a tubular shape.
Patient recovery is usually rapid and the entry does not usually take longer than 2 or 3 days, although the urinary catheter is maintained, depending on the technique used, up to three weeks.
Later you may be needed during a season calibrations ambulatory urethra to check the urethra becomes not constrict. We not recommend dilatations of the urethra as definitive treatment for male urethral stricture, but those made after surgery can help the healing process and prevent restenosis; only they performed in selected cases, hence the importance, once again, to individualize treatment.
In the female urethra stenosis you can try to perform dilations start and, depending on the outcome, raising surgery in case of recurrence.
As for the results, the success rate is variable depending on the characteristics of the stenosis, but close to 85-90%.
What is hypospadias?
As mentioned before this is an abnormal position of the end of the urethra in the penis, visible up to 5 in every 1,000 men birth. In this case the urethral meatus is below the glans penis body or even more proximal, accompanying a penile curvature "down".
Generally not accompanied by urethral stricture so the child can urinate
without difficulty, but the early surgical correction is advised (between 3 and 18 months of age) to avoid psychological problems associated with an abnormal appearance penis.
There are countless surgeries to correct the position of the urethral meatus and penile curvature, depending on the severity of the process techniques.
The first is to make an accurate diagnosis before symptoms that can be mistaken for a prostate condition in male or a problem of recurrent urinary tract infections or painful bladder in women. The choice of the most appropriate surgical technique for each patient is crucial and rigor inform both the disease and the technique that we will use and its impact. Urethral surgery is technically demanding and requires years of practice to be carried out with guarantees.