The urethra is an open tubular canal that provides both urinary bladder and urine excretion. The outer urine channel is also known as the external urinary tract. The inside of the urethra is covered with a layer called mucosa. The hole where the urethra is opened to the outside is called a meatus.
The primary function of the urethra in men and women is to let urine out of the body after the bladder has started its excretory function. Sunjay Kulkarni drew attention to the problem of urethral stenosis is more common in men and continued:
This thin channel also plays an important role in sperm output in men. A stenosis caused by injury and infection prevents or slows the flow of urine in this tube. This condition is called urethral stenosis. Urethral stenosis is a problem affecting the quality of life, but serious or complete obstruction is inevitable.
Urethral stenosis occurs when a portion of the urethral canal is narrowed. Any part of the urethra may be affected by this narrowing. As a result of constriction around the affected part of the urethra, some fibrosis or connective tissue is usually formed. The length of the narrowing begins at 1 cm and varies according to the exact length of the urethra.
Because the urethra of women is shorter, the risk of urethral stenosis is lower for women. In men, the canal is more likely to be narrowed as the canal extends along the penis. Once the urethral narrowing occurs, it does not recover spontaneously and may require surgery.Urethral stenosis surgery in men or women is a processto remove the narrowing bythe surgical procedure.
What are the causes of Urethra Stenosis?
The most common cause of urethral stenosisis past infections. Sexually transmitted diseases such as gonorrhea may cause urethral stenosis unless treated. In addition, urethral catheter insertion through the urethra, cystoscopy, closed prostate and bladder cancer surgery and failed hypospadias surgery, traffic accidents, high falls in the style of horses and external urethra can lead to urethral stenosis. Sometimes, ureteral stenosis may occur due to unknown reasons.
What are the Symptoms of urethra stenosis?
Slowdown in urine flow
Pain during urination
Bifurcation of urine
Scattering of urine from right to left
Dripping after urinating
Reduction in urine pressure
Fine excretion of urine
Reduction of urine forward
Difficulty in urination
The Diagnosis of Urethra Stenosis
In patients with urethra stenosis, symptoms such as urinary stress, urinary pressure reduction and urinary incontinence can be seen which are the symptoms of urethrastenosis. Therefore, first of all, patients should be examined about such complaints.
In the examination, the external mouth of the urinary canal should be examined and the traces of the operation in the penis should be sought. Auroflowmeter test, known as a voiding test, should be performed. In this test, the urine flow rate can be seen at low rate. The typical voiding curve of patients with urethra stenosismay be observed. The urethra film called retrograde urethrographycan be monitored.
Treatment of Urethral Stenosis
It is not possible to treat urethral stenosis with drugs. There are three methods used in the treatment of urethral stenosis. These include dilatation, endoscopic closure of the stenosis (urethrotomy intern) and urethoplasty. The treatment method to be selected depends on the cause, location, length and severity of the stenosis.
Endoscopic Surgery (Direct Vision Internal Urethrotomy)
Endoscopic surgery or direct vision internal urethrotomy in the other name, is applied when the stenosis in the urethra is shorter than 2 cm. In this operation, a special device with light and camera is used. With this tool, it is entered through the urine canal and the area which is narrow is cut and opened by the blade or laser light at the end of the instrument.
This operation is completed in about one hour. After the stenosis is opened during surgery, a catheter is inserted into the patient. This probe stays for 3 days. Sometimes after this catheter has been taken, some patients are asked to insert a probe with a single-use special probe several times a day. This probe is taken after 10-15 minutes. The aim of this method is to prevent or delay the narrowing of the urethral canal opened by closed surgery.
After closed surgery, the stenosis in the urinary tract is usually repeated, and the patient may need to be reoperated. Closed surgery should be performed no more than 2 times. That is, more than two residues should not be performed because the number of closed operations increases and the area of stenosis increases. The success rate of closed surgery varies between 35-70%. Closed surgery is not recommended for childhood urethral stenosis.
Open surgery (urethroplasty)
Open surgery is recommended in patients with recurrence of stenosis and a stenosis length of more than 2 cm if it has not provided benefit from closed surgery. Open surgery is known as urethroplasty.
There are different urethroplasty techniques. Urethroplasty may take 2-3 hours depending on the method applied. In this surgery, depending on the location of the urinary tract stenosis, either the lower part of the penis or an incision made just below the testicle, the stenosis area in the urinary tract is reached. If the length of the stenosis is shorter than 2 cm, this area is removed and the remaining healthy tissues are joined together to form a new urine channel. If the stenosis is longer than 2 cm, this end-to-end method is not applied. In this case, patching is performed on the stenosis region. Penile skin or cheek mucosa is used for the patch to be used. After the operation, the patient remains in the probe for 2-3 weeks.
Some patients have completely closed urine. Stenosis in the urinary tract may not be treated by a single operation in these patients. In those people whose urine canals are completely closed, if there is not enough tissue for the patch or the penis structure is not suitable for patching or there is a risk of anesthesia for long-term surgery, the urethra is temporarily mouthed just below the testicle bag. Six months after this procedure, a new operation is performed to bring this urinary canal to the tip of the penis located in the lower part of the testicle bag. If the patient does not want a second operation, the urine can be left permanently in the lower part of the testicle bag. However, these people cannot urinate by standing and can urinate by sitting.The rate of recovery of urethra stenosis with open surgery is 90-95%.
Permanent Probe to the Urinary Bladder
Another option is to place a permanent catheter in the bladder from the abdomen. This probe is replaced at regular intervals and people continue their normal lives. Depending on the presence of a long-term probe; conditions such as urinary tract inflammation, fever, bladder stone formation and shrinking of the bladder capacity can be seen