Stenosis or urethral stricture is a scar in the urethra itself, which can block the flow of urine and cause the patient to urinate with little force.
Causes of urethral stricture
Normally its causes are congenital, inflammatory, infectious or traumatic although a significant number of cases the cause is unknown.
Direct trauma to the penis and especially the soundings or to the bladder catheterizations are a common cause of urethral stricture.
Today an increase in stenosis associated with inflammatory sclerosus obliterans xerotica skin disease called balanitis or Lichen behaving much more similar to that traumatic inflammatory strictures observed.
Symptoms of urethral stricture
Most patients suffer from symptoms associated with lower urinary tract such as delay in starting urination, weak urine stream, dribbling at the end of urination and feeling of incomplete emptying.
Treatments for urethral stricture
- Periodic urethral dilations (treatment inadvisable): proceed to introduce dilators into the urethra of the patient until a proper gauge that allows you urinate acceptably for a variable time for each patient, about 20-45 days until it is closing again ( depending on the case).
- Internal urethrotomy (endoscopic) internal urethrotomy direct vision through a camera (endoscopically) it is performed by transurethral incision cold knife or cuchillete to release the scar tissue, allowing the tissue to heal by secondary intention in larger caliber and thus increase the size of the urethral lumen. (Not recommended and a poor success rate)
- Urethroplasty (open surgery) technique of choice (gold standard) This is surgery to perineum opened by locating and removing the stenosis is producing narrow segment stenosis. Sometimes it is necessary to use grafts if the defect is very long. The success rate in the hands of experts in urology ranges between 70% and 97% success rate at 5 years.
We must always consider urethroplasty (open surgery on the urethra) through the perineum as the main option in all cases of treatment and in all cases of patients who failed prior urethrotomy.
To make a Urethroplasty, the urologists use many different techniques, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection and reconstructive techniques.