Narrowing of the urinary canal in men treatment. Treatment methods for urethral stricture in men

male urethra, or urethra, urethra masculina, is a hollow unpaired organ. It has the shape of a tube that originates with an internal opening, ostium urethrae internum, in the anterior-lower part of the bladder and ends with an external opening, ostium urethrae externum, on the head. There are three parts urethra:
- Prostatic part, pars prostatica;
- The membranous part, pars membranacea;
- Spongy part, pars spongiosa.
prostatic part, pars prostatica, the urethra penetrates the prostate gland into vertical direction. Its length is 30-35 mm. The middle section of the prostatic part is expanded, and the initial and final ones are narrowed. On back wall the prostatic part of the urethra is located seminal tubercle, colliculus seminalis, and on the sides of the tubercle - numerous excretory ducts.
membranous part, pars membranacea, the urethra penetrates the urogenital diaphragm 15-20 mm long from the top prostate to the bulbus penis. The diameter of the membranous part ranges from 3-4 mm. This is the narrowest part of the urethra, which must be taken into account when inserting instruments through the urethra into the bladder. The membranous part of the urethra is limited by tufts of striated and smooth muscles, which form an arbitrary urethral closure, m. sphincter urethrae.
sponge part, pars spongiosa, is the longest part of the urethra, its length is 100-120mm. The urethra is divided into bulbous and hanging sections, the diameter of the lumen is 6-10 mm. Numerous urethral glands open into the bulbous urethra, gll. urethrales, and ducts of the bulbourethral glands, gll. bulbourethral (Cowperi).
The male urethra has three constrictions: inner hole, in the membranous part and at the external opening, as well as expansion: in the prostatic part, in the bulb of the male penis and in front of the external opening, in the navicular fossa, fossa navicularis. Along the entire length of the urethra, two bends are formed in the sagittal plane - upper and lower. In children, the prostatic part of the canal is longer. The lumen of the urethra expands during the passage of semen and urine, and when introduced into the urethra (catheter, cystoscope).
In clinical practice, the urethra is divided into two sections: the back part is fixed and the front part is movable. The fixed section, in turn, is divided into intravesical (5-6 mm long), prostatic (30-35 mm) and membranous (15-20 mm). The intravesical section is the sphincter of the bladder.

The structure of the male urethra

The wall of the urethra consists of three membranes:
- Mucous membrane, tunica mucosa;
- Submucosa, tela submucosa;
- Muscular membrane, tunica muscularis.
In the spongy part of the muscular layer is absent. In the mucous membrane there are many mucous glands, gll. urethrales. In the submucosal layer, there are around-urethra lacunae, which can be the site of specific and non-specific inflammation. The muscular coat is well developed in the prostatic and membranous parts and has two layers: the inner one is longitudinal and the outer one is circular. The circular layer of muscles in the initial part of the urethra forms an arbitrary internal sphincter of the urethra, m. sphincter urethrae intemus. In the membranous part, the urethra is limited by the muscle - the urethral opener, m. sphinter urethrae, which is an arbitrary sphincter of the urethra.

Topography of the male urethra

The male urethra is located in the pelvic cavity and in the spongy substance of the penis. The prostatic part of the urethra is bounded on all sides by the prostate gland. The membranous part passes through the urogenital diaphragm. The bulbourethral gland adjoins its posterior surface, gl. bulbourethralis (Cowperi).
X-ray anatomy of the male urethra. Filling the urethra contrast agent it looks like a tube, on which its narrowing is visible.
blood supply The male urethra is carried out by branches of the inferior urinary-vesical arteries, the arteries of the bulb of the male penis and the arteries of the urethra. The veins of the canal form the venous plexus. Venous outflow carried into the vesical and perineal veins.
lymph outflow carried out from the prostatic and membranous parts of the canal to the internal iliac, and from the spongy - to the inguinal lymph nodes.
innervation the male urethra is carried out by branches, nn. penis and n. dorsalis penis. and also plexus prostaticus.

Urethral stricture is an anatomical narrowing of the urethra, resulting in difficulty urinating. This is a fairly common pathology, detected in 2% of males and 1% of women.

In most cases, stenosis occurs in men, since their urethra is much longer than in women and is more prone to injury. Some urologists argue that in fact there are much more male patients with such a diagnosis than 2%, they are simply mistakenly diagnosed with prostatitis, cystitis or. And to identify the stricture of the urethra in men and treat it only after serious research.

Narrowing of the urethra can occur in people of any age. Most often it occurs in the anterior part of the urethra.

Note! Any damage to the epithelium can lead to the appearance of scar tissue that blocks the exit of urine.

Causes of urethral stenosis

The causes of pathology can be:

Genital trauma.
Penis fracture.
Penetrating knife or gunshot wounds of the anterior urethra.
Catheterization (especially for long-term operations).
Surgical interventions.
Pelvic fractures as a result industrial injuries or falls from a height.
radical prostatectomy.
Venereal diseases, the causative agents of which are trichomonas, chlamydia, mycoplasmas, gonococci.
Tuberculosis of the genital organs.
Chemical damage to the urethra as a result of self-medication.
Deterioration of the blood supply to the genital area with systemic vascular atherosclerosis or diabetes mellitus.

Classification

Strictures are classified depending on the cause of development and the nature of the damage to the urethra.
By the nature of the flow.

primary form. It is diagnosed in the event that the disease in a patient is detected for the first time.
Recurrent. It is determined if, after treatment, the disease develops again after bougienage, stenosis or urethroplasty.
Complicated. Complications are considered fistulas or abscesses.

By the nature of the disease.

Traumatic. They are caused by trauma to the genital organ resulting from blows, wounds or medical manipulations.
Inflammatory. It is the result of inflammation of the urethra, which is caused by pathogenic microorganisms sexually transmitted.
Congenital. The reason why this pathology occurs has not been established.
Idiopathic. At the same time, the causes of urethral stenosis that appeared in adulthood fails to find out.

By location.

Capitate, penile and bulbar stricture is formed in the region of the external opening of the urethra.
Prostatic and membranous. Stenosis of the posterior urethra.

In count.

Single. The narrowing occurs in only one place.
Multiple. Strictures form at several sites in the urethra.

To size.

Short. The length of the narrowing is not more than one centimeter.
Average. The length of the constriction is from one to two centimeters.
Long. The narrowing is more than two centimeters long.

According to the degree of damage.

subtotal stricture. In this case, 2/3 of the urethra is affected.
Panurethral stricture. Narrowed almost the entire urethra.
Obliteration. The lumen of the urethra is absent and complete obstruction occurs.

Symptoms of the disease

Problems with urination indicate a narrowing of the urethra. You can determine the disease by the following symptom:

In order to start the act of urination, you need to make an effort.
The stream of urine weakens and splashes, despite the tension of the abdominal muscles.
After the end of urination, there is a feeling that the bladder is not completely emptied, and new urges appear.
In some men, the disease is accompanied by urinary incontinence.

Additional symptoms that indicate the disease:

Aching pain in the lower abdomen and genital area.
Weak release of semen during ejaculation.
An admixture of blood appears in semen or urine.
Mucous discharge appears after urination.
There may be pain and burning in the urethra during the act of urination.
The volume of urine decreases.
In the event that almost the entire urethra is narrowed, urine is excreted in drops.
With obliteration, urine does not leave the bladder. This is very dangerous state and without timely assistance, a fatal outcome is possible.

Note! In women, the disease also manifests itself in the form of a violation of the act of urination, sensations are not complete emptying bladder, burning and pain in the urethra. But obliteration is very rare.

Complications

Violation of the outflow of urine leads to the fact that the annular muscle at the outlet of the bladder is overstrained, and subsequently atrophies. As a result of this, her contractility decreases. The bladder stops emptying completely, and residual urine accumulates in its lumen. If its volume is more than 100 ml, this is a serious pathology and can lead to diseases such as:

Pyelonephritis.
Cystitis.
Orchitis.
Prostatitis.
Urolithiasis disease.
Renal failure.
Diverticulitis.
Hydronephrosis.

Diagnostics

In order to diagnose the disease, the doctor collects an anamnesis, finding out how long ago the problems began and what exactly preceded this. The patient may be asked to make a diary in which he will have to record the frequency of urination, the volume of urine, urge intolerance, possible leakage of urine. You will also need to record the amount of fluid you drink.

Additional examinations are carried out:

General analysis of blood and urine.
Bacteriological examination of prostate secretion and urine.
Comprehensive ultrasound examination urinary organs.
Uroflowmetry (determination of the amount of urine excreted, the duration of the act and the rate of urine flow).
Urethrography ( x-ray examination urethra with contrast).
Tomography of the pelvic organs (if necessary).
Endoscopy (examination of the affected area with an endoscope).

Treatment

Treatment of urethral stricture with drugs or alternative methods is almost impossible.

In order to solve the problem, it is necessary to carry out bougienage, urethrotomy or urethroplasty.

Urethral bougienage

It is one of the most common treatments for urethral stricture in women and men. Its essence lies in the fact that with the help of a special tool made of durable material, the narrowed area expands.

To get rid of the stricture of the urethra, a bougie with a large diameter is introduced each time. Before the start of the session, the man must spend hygiene procedures.

The patient is seated in a special chair. The head of the penis and the instrument itself are treated with a special gel, and the doctor begins to gradually insert the bougie into the urethra. It is advanced until it reaches the bladder. Then leave for 5 - 10 minutes, remove and replace with a tool of a larger diameter. Bougie is changed until there are difficulties with their extraction.

After the procedure, the urethra is treated with an antiseptic and antibiotics are prescribed in order to avoid the development of the inflammatory process.

Note! The procedure is quite complicated, since the instrument must pass prostate and the bottom of the small pelvis, so the specialist who conducts it must have the appropriate experience.

Disadvantages of the method:

The result of bougienage is temporary. The procedure does not improve blood circulation in the affected area, therefore, over time (in some cases even after a month), stenosis reappears, while the narrowing becomes longer, and tissue scarring intensifies.
During the procedure, damage to the urethra is possible.
After bougienage, inflammatory processes may occur in the genital area.

Note! The bougienage method is not used for acute urethritis, cystitis, pyelonephritis, chronic strictures or complete infection of the urethra.

Internal urethrotomy

This method is used for strictures no longer than 1 cm. The procedure lasts about thirty minutes. 8 hours before the urethrotomy, you can not eat or drink water. Before starting, hygiene procedures are carried out. The patient is given general or epidural anesthesia and placed in a chair.

A cystoscope is then inserted into the penis to look for strictures. With the help of a special cold knife, scar tissue is cut off and the urethra expands. Then the doctor performs additional research bladder area. After the procedure, a catheter is inserted into the urethra.

Disadvantages of internal urethrotomy:

The possibility of damage to the urethra and the development of the inflammatory process.
Recurrence of urethral stricture and the need for another operation.
Pain in the genital area.
Erectile disfunction.
Scarring of tissues.
Possibility of bleeding.
Pain when urinating.

Urethral stenting

The procedure is used if the patient has serious problems with health and general anesthesia is contraindicated for him. This is a minimally invasive treatment for urethral stenosis. In order to eliminate the narrowing inside, a special mesh or mesh tube is installed. spiral structure. It may be permanent or resolve through certain time. Urethral stenting is performed under local anesthesia.

Disadvantages of the procedure:

The mucous membrane of the urethra can grow through the hole in the stent, which not only blocks the flow of urine, but also creates certain difficulties in removing the device.
It is possible to encrust the stent with salts.
Displacement of the stent is a rather serious complication, it can not only cause urinary retention, but also make it difficult to remove the device.
Due to improper selection of the length of the stent or the choice of installation site, urine leakage may occur.

Note! Usage the latest technologies in the production of these fixtures solves most problems and simplifies installation. In the event that absorbable materials are used, displacement and germination of the mucous membrane is excluded.

urethroplasty

Urethroplasty is surgery, with the help of which the normal lumen of the urethra is restored. There are a variety of methods, depending on the size of the stricture, its location, and complications.

Before surgery, a man must pass all necessary tests. The operation is carried out under general anesthesia. Reconstruction is performed through an incision in the skin between the scrotum and anus. During a certain period, the patient remains in the hospital under the supervision of medical personnel.

With a total lesion of the urethra, it is necessary to completely restore the urethra along its entire length. To do this, transplant tissues taken from inner surface forearm. The method is quite complicated, but the reconstruction of the urethra can be performed in one step.

If the narrowing of the urethra is short and located in the bulbous or membranous section, then the affected area is excised, and the two normal ends are connected. In the event that this is not possible, the defect is eliminated with the help of other tissues, such as the skin of the penis or the buccal mucosa. The field of which a catheter is installed for a period of 10 to 21 days.

Depending on the complexity of the task, urethroplasty can be performed in two stages or even several, the period between which is from 4 to 12 months. The method is selected individually after determining the patient's problems.

Disadvantages of the method:

Stricture recurrence.
Narrowing of the external opening of the urethra.
The appearance of fistulas.
Deformation of the penis.
Urinary incontinence.

Several complications may occur at the same time.

Recovery period

After the procedure to expand the urethra, a period of rehabilitation is necessary. At this time, you must adhere to the following rules:

Take antibiotics and pain medications prescribed by your doctor regularly.
If there is a catheter, it must be regularly looked after.
Within 2 weeks after the operation, you should refuse to take a bath, visit the pool, sauna, bath or swim in open water.
It is possible that in order for the scar tissue not to block the urethra again, the catheter will have to be inserted and removed several times a week.
Within a month after the procedure, you can not lift weights and engage in heavy physical labor.
Must be consumed enough liquids. It is not recommended to drink carbonated drinks and alcohol.
You need to eat right and stop eating salty and sour foods.
You can't have sex for two weeks after the operation.
In the event that there are problems with urination, the catheter does not drain urine, the volume of urine has changed, the frequency of urination has changed, signs of an inflammatory process have appeared, or a large number of blood in the urine, you should immediately seek medical advice.

Disease prevention

In order to prevent narrowing of the urethra in men, you must adhere to the following rules:

Avoid casual sex.
Use condoms when having sex with new or unreliable partners.
If you experience symptoms such as pain during urination, rash or discharge, seek medical advice immediately.
In the treatment of urological or sexually transmitted diseases follow all doctor's instructions.
Avoid trauma to the genitals.
Do not abuse Miramistin and Chlorhexidine solutions, which are used to prevent sexually transmitted diseases and are injected directly into the urethra. At hypersensitivity to such drugs, even a small concentration of substances can cause a burn of the mucous membrane.

If you have problems with urination, you can not self-medicate, and in without fail you need to seek help from a urologist. On early stages you can get rid of the disease quickly. Lack of timely treatment can lead to the need for several major operations.

Urethral stricture in men is a disease that is expressed in the narrowing of the urethra and the appearance of scars on the mucous surface of the urethra.

According to ICD 10, this disease has the code N35.9. She is more often male than feminine reason physiological features structures of the urethral canal.

Symptoms of narrowing of the urethra can often be confused with other urological diseases. However, if you notice any of the following signs you need to immediately contact an andrologist and start treatment:

difficulty urinating;
frequent urge to urinate;
splashing of a stream of urine;
change in the color of urine;
blood in the urine (hematuria);
lower back pain.

Most of these symptoms may be absent or appear gradually. It is extremely difficult to determine the narrowing of the urethra on your own. With any of the symptoms listed above, you should immediately go to the urologist.

Diagnostics

If a man has symptoms of a stricture, a thorough diagnosis is carried out:

inguinal region;
kidneys;
urethra.

To do this, research is carried out in the laboratory and screening studies. The man takes:

smear to exclude infections and diseases of the genital tract;
Analysis of urine;
blood;
seeding of renal tissue.

Then an ultrasound is performed, and in order to make a final diagnosis, uroflowmetry is done.

One type of ultrasound is transrectal

Uroflowmetry

A uroflowmeter is used to determine how fast a patient is urinating. A man is given a special container in which he collects urine. This container is located in the apparatus, which, after the completion of the process, shows the result.

Having found a urethral stricture in men, it is immediately important to begin treatment.

Radiology

For the diagnosis to be correct, the urologist needs to determine the location of the narrowing and its length. For this, retrograde urethrography is used. A special solution is injected into the canal, then an x-ray is taken.

These manipulations help to see the full picture of the disease.

Treatment

After complete diagnosis need to start treatment. In no case should you do it yourself, it is not only ineffective, but often even dangerous. Always consult a doctor.

Due to special physiological structure male urethral therapy is quite complicated. The doctor prescribes drugs, and depending on the form of the disease, the size of the stricture and other parameters, looks at what operations the patient needs. It is important to note that there are quite a few such methods.

Dynamic Surveillance

If the complaints are minimal and the disease has just begun to develop, and there is no infection, then the doctor simply observes the patient. Often in this case, I prescribe antibacterial drugs. Andrologist monitors until the appearance obvious signs diseases.

Bougienage of stricture

The narrowing of the urethra in men is stretched using a metal rod. This method is effective for short strictures.

When bougienage is very often there are relapses. The tissues begin to scar again, the stricture lengthens. The method cannot be applied again, as there will be no healing.

Optical urethrotomy

With the help of special instruments, a cystoscope and a ureteroscope, the urethra is cut with a laser or a sharp scalpel in a narrow area. At this method also has its drawbacks, as most patients complain of relapses. The second time to use such an intervention is not allowed.

Cystoscope

Stening

The procedure causes complications and relapses because the stent is often displaced from the central position.

urethroplasty

This operation is the most modern method of therapeutic effect in constriction male urethra. Effective for strictures of any size.

With narrowings of a small length, less than two centimeters, the urethral canal is cut and changed to a healthy part.

The effectiveness of the method is quite high. If the length of the narrowing is more than two centimeters, a graft is used for which skin is used. foreskin or buccal mucosa.

Such operations give good result and they have no relapses. The price of urethroplasty ranges from 15 to 100 thousand rubles, depending on the complexity.

Laser treatment

This method is used in many medical centers. laser treatment does not cause injury to the patient, but over time there are relapses.

Men work on the urethral canal with a laser. After the operation on the canal, anti-burn ointments and solutions are introduced.

If the drugs are not administered correctly, a scar appears at the site where the stenosis was. Due to individual physiological characteristics, even with a small surgical intervention, the channel narrows again.

The price of this operation can be found in any medical institution.

Endoscopic method

This operation on constrictions is performed using an endoscope, only on short strictures. An endoscope is inserted into the urethral canal and tissue is cut.

After the operation, urination is restored for a short time. This method is an emergency, reviews on it are mostly positive.

Home Treatments

To avoid remission of the disease and its complications, after the operation, you can be treated with herbs. The following is detailed description folk methods.

Herbal decoctions

To prepare a decoction, you need to mix chamomile, lingonberry grass, poplar buds and black elderberry leaves. Then take two large spoons of chopped herbs and add 500 ml of boiling water to them. The broth must be covered and insisted throughout the day.

Take it one tablespoon before meals. Such folk method treatment is not recommended for more than ten days.

Hirudotherapy

One of folk remedies is hirudotherapy. During treatment medicinal leeches swelling is reduced, inflammation is relieved after surgery, and blood circulation improves.

Such ethnoscience helps after surgery.

Prevention

Stricture can affect any man, regardless of age. To avoid this, do the following:

observe the rules of personal hygiene and be sure to use contraceptives;
treat all inflammatory processes in the urethra in time;
immediately perform an operation in case of injury to the urethral canal;
do not enter foreign objects into the urethra;
lead active image life and harden the body;

Compliance with these procedures will help the patient avoid problems with many urological diseases.

Conclusion

For men's health constant monitoring of problems with urology is necessary. If this disease is not noticed in time, serious complications can develop.

If the disease has manifested itself, it is necessary timely help doctors and modern methods of treatment. It is important to constantly be observed by a urologist. But even if the patient asked for help on time, relapses are possible.

To organ pathology genitourinary system urethral stricture in men and women. This is a condition in which the lumen of the urethra narrows. This pathology complicates the process of excretion of urine and facilitates the penetration of microbes.

Narrowing of the urethra in men occurs in 1-2% of cases. Among women this pathology is diagnosed less often due to the fact that their urethra is wider and shorter. In men, the canal is more prone to injury. Stricture can be congenital or acquired. Depending on the main etiological factor, there are the following types this pathology:

inflammatory;
traumatic;
iatrogenic.

Stenosis is first-time, recurrent and complicated. The process involves the anterior or back department urethra. This state dangerous because it can contribute to the development of urethritis, pyelonephritis, hydronephrosis and urolithiasis.

Etiological factors

Stricture is due to several reasons. Main etiological factors are:

congenital developmental anomalies;
penetrating wounds;
careless smear taking;
fracture of the pelvic bones;
falling from a height;
exposure to caustic chemicals;
burns;
medical manipulations;
difficult childbirth;
performing operations on the pelvic organs;
specific and nonspecific urethritis;
balanitis;
systemic atherosclerosis;
damage during sexual intercourse;
exposure to ionizing radiation.

The narrowing of the urethra is based on the following pathological processes:

circulatory disorders;
inflammation against the background of the penetration of microbes;
mechanical damage;
proliferation of granulation (scar) tissue.

Congenital organ developmental disorders are rare. Most common cause is trauma. Stricture is possible on the background of a fracture of the penis or accidental entry into the canal foreign objects. Iatrogenic narrowing of the urethra is common. The reason is incorrectly performed medical manipulations (catheterization, bougienage, cystoscopy, removal of the prostate gland, examination of the urethra).

In 15% of cases, the narrowing is due to the inflammatory process. It can be either chronic or acute urethritis. Risk factors are:

unprotected sex;
engaging in commercial sex;
the presence of an STI;
engaging in non-traditional sex;
homosexuality.

Urethral stricture in women and men occurs against the background of a specific and nonspecific inflammatory process. In the first case, the cause is the penetration and reproduction of gonococci, chlamydia or Trichomonas. The ingress of bacteria is possible with diseases of other organs (tuberculosis).

Clinical manifestations of stricture

Symptoms of urethral stenosis are nonspecific. Difficulty urinating comes to the fore. The following symptoms are possible:

feeling of a full bladder;
pain during micturition;
jet bifurcation;
change in the color of urine;
pain in the lower abdomen;
involuntary leakage of urine;
discharge;
weak jet pressure;
retention of urine at the beginning of micturition.

The clinical picture largely depends on the cause of the stricture. If it is mechanically damaged, then pain (resin) may appear. Traces of blood appear in the urine of such people. This condition is called hematuria. It is macroscopic and microscopic. In the first case, urine becomes pinkish in color.

With stricture against the background of urethritis, discharge is possible. Most often they are purulent. With gonorrhea, the discharge is yellowish. When urinating, patients feel discomfort. Such people have to tighten their abdominal muscles to expel urine. The severity of dysuric disorders is determined by the degree of stricture.

In severe cases, urine is excreted drop by drop. This is fraught with overflow of the bubble and its ruptures. At acute delay urine urgently required health care. getting worse general state sick person. In men, the symptoms are similar to those in women, but in addition to this, there is a decrease in the strength of ejaculations. If the cause was a long-term urethritis, then a violation of potency is possible.

Complications and possible consequences

If a sick person is not treated, then there is a high probability of developing complications in the future. The following consequences are possible:

pyelonephritis;
cystitis;
orchitis;
inflammation of the prostate gland;
bleeding;
acute urinary retention;
hydronephrosis;
kidney failure.

Complications often occur after surgery. Relapses, bleeding, stent displacement, and tissue soaking are possible. With narrowing of the urethra, the barrier function of the mucous layer may be impaired. This contributes to the penetration of bacteria into the urethra and other organs (bladder, kidneys).

Complaints about frequent and painful micturition may indicate the development of cystitis. These people have pain in the pubic area. It intensifies during micts. With the development of pyelonephritis against the background of urethral stricture, pain appears in lumbar region and sharply change the indicators of urine. Obstruction of the outflow of urine and its return to the kidneys can lead to the development of hydronephrosis.

Patient Examination Plan

If you suspect a narrowing of the female or male urethra, the following studies will be needed:

smear analysis for STI pathogens;
analysis for syphilis;
general blood and urine tests;
inoculation of material from the urethra to isolate a culture of bacterial cells;
polymerase chain reaction;
linked immunosorbent assay;
ureteroscopy;
rectal examination;
uroflowmetry;
urine culture;
Ultrasound of the bladder and kidneys;
X-ray contrast study;
cystoscopy.

Additional diagnostic methods are cystometry, video urodynamic study and profilometry. Infectious nature strictures confirm lab tests. Immunofluorescence reaction and PCR are carried out. They allow you to detect the causative agent of the infection. The material for the study is a smear from the urethra. IN general analysis urine, the following changes are possible:

hematuria;
leukocyturia;
pyuria;
the presence of protein.

Studies that evaluate the rate of excretion of urine are very effective. With stricture, there is a slowdown in the onset of micturition and a lengthening of the total time. The volume of residual urine must be determined. To identify the exact localization of the stricture, the size of the affected area, diverticula and false passages, an x-ray examination using a dye will be needed.

Informative urography: a dye is injected into the patient through the external urethra, after which a picture is taken and the contrast distribution is assessed. Often held intravenous urography. In this situation, the solution is injected. To determine the condition of the mucous membrane of the urethra and exclude other pathologies (tumors, urolithiasis), an examination is performed using a ureteroscope.

A preliminary diagnosis is made on the basis of a survey and examination of the patient. The urologist must establish when the first complaints appeared and what preceded this. The symptoms present at the time of examination are specified. The doctor must clarify the nature of the patient's sexual life. Palpation of the abdomen, examination of the genitals and the external opening of the urethra are mandatory.

Therapeutic tactics for stricture

Medical treatment for this pathology is ineffective, since it does not allow to remove scar tissue. Modern methods therapies are:

bougienage;
urethrotomy;
stenting;
cystostomy;
resection;
urethroplasty.

Surgery for urethral stricture strict indications. Bougienage is organized in order to expand the lumen of the organ. For this, special metal rods or balloon catheters are used. They stretch the tissue at the site of injury and thereby expand the lumen of the urethra. First, small diameter rods are used. Then it is increased.

Very often bougienage is supplemented drug therapy. Appointed enzyme preparations(Lidaza). They contribute to the resorption of scar tissue. Sometimes corticosteroids are prescribed. The disadvantages of bougienage are pain, the possibility of damage to the mucosa and the risk of relapse.

Laser treatment of urethral stricture is practiced. This is a modern and very effective method. Similar treatment often difficult due to poor tissue availability. When the urethra is narrowed, stenting is often performed. A certain mesh design is installed, which provides the desired diameter of the urethra.

Stenting is indicated when it is impossible to perform open operation, small (up to 0.5 cm) zones of narrowing and lesions of the bulbar and bulbomembranous sections. It's minimally invasive surgical intervention. Stents are either temporary or permanent. Such treatment is not carried out with a pronounced narrowing of the urethra, chronic recurrent infections, urinary incontinence and after surgery.

With extended strictures, resection followed by urethroplasty is the most effective. Transplants from their own tissues may be required. Rarely, urethrotomy is performed. This is a procedure in which an internal incision is made in the urethra. For this, special tools are used. In case of complete urinary retention, a cystostomy may be performed.

Rehabilitation and health prognosis

After treatment, it is important to prevent infection and purulent complications. For this you need:

eliminate the risk of urine leakage into the area of surgical sutures;
observe sterility;
install a catheter;
use antiseptic solutions.

After the operation, patients are advised to refrain from sexual intercourse for a while. In the absence of complications on the background of treatment, the condition improves. The outflow of urine is normalized. In order to speed up the process of tissue regeneration, physiotherapy is carried out (galvanization, exposure to magnetic fields).

After the operation, you need to follow the diet number 7. This is due increased load on the kidneys. Health food aimed at excluding from the menu products that have a diuretic effect. These include alcoholic drinks, marinades, spices, watermelons, cranberries and lingonberries. They increase diuresis. At timely treatment the prognosis is favorable.

Stricture Prevention Methods

Preventive measures are aimed at eliminating the main risk factors for narrowing of the urethra. To avoid similar problem, necessary:

prevent STIs;
exclude unprotected (especially anal) sexual contacts;
refuse casual connections;
observe the rules of personal hygiene;
do not overcool;
wear warm underwear in the cold season;
exclude foreign bodies from entering the urethra;
at least once a year to be examined by a dermatovenereologist;
timely treat specific and nonspecific urethritis;
observe sterility and caution when performing medical procedures;
prevent falls, fractures and other injuries.

Men during sexual intercourse need to be careful not to damage the urethra. Urethral stricture can be caused by medical workers, so you need to strictly know the technique of catheterization, ureteroscopy and other procedures. Thus, the narrowing of the urethral canal in men and women is dangerous pathology. Self-medication and the use of drugs can lead to complications up to kidney damage.

Urethral stricture is urological disease, which is characterized by a narrowing of the lumen in the urethra due to the cicatricial-sclerotic process. The causes of the disease are different, but the result is always the same - a violation of the normal outflow of urine from the cavity of the bladder. This diagnosis gives men psychological and physical discomfort.

If the patient ignores the problem, then the disease will “pull” with it whole line serious complications(spongiofibrosis, renal failure, hydronephrosis, various bleeding). Urethral stenosis in children is great danger, because pathological disorders occur in an organism that is not yet fully formed.

Strictures have a different etiology. According to the nature of the course, they are divided into primary, repeated, or diseases that occur with complications. medical practice shows that obstruction is localized either in the front of the urethra, or in the back, located near the bladder.

Why is it so important to diagnose and eliminate strictures in the urethra in time? The fact is that the obstructed outflow of urine provokes reproduction infectious bacteria. It suffers a lot important organ- kidneys. And such consequences may well threaten the life of the patient.

Urethral strictures can be congenital or acquired during a person's life. In the first case, the disease is caused exclusively congenital anomalies development of the urogenital organs (narrowed urethral stents are formed in boys in the womb).

Acquired obstruction of the urethra in men occurs in the following cases:

Injuries received throughout life (the so-called post-traumatic urethritis). They include mechanical damage drop, shock, thermal or chemical burn tissues, penetrating wounds in the genital area. Post-traumatic urethral stricture occurs after fractures pelvic bones(industrial accidents, falls from a great height). Often damage to the urethra occurs during sexual contact (tears in the external tissues of the penis with bleeding). Damage and scarring develops after large stones pass through the canal during ICD (urolithiasis).
Unskilled or incorrectly performed urological manipulations and surgical interventions.
Acute or chronic inflammation in the tissues of the urethral canal ().
Strictures due to radiotherapy. The disease becomes a complication after treatment cancerous growths or benign tumors urinary system.
obstruction, which is secondary disease with ailments that are characterized by a violation of the normal blood supply to tissues in the pelvic area. They include arterial hypertension, myocardial ischemia, diabetes, deviations in the functioning of the pancreas.

Most often when compiling clinical picture diseases are noted precisely its acquired causes. Congenital pathologies occur in only 2% of patients.

Symptoms of the disease

The narrowing of the urethral passage is a pathology that is accompanied by pronounced, painful symptoms. It manifests itself most often as follows:

Difficulty passing urine through the canal. Discomfort is felt at the beginning and throughout the act of urination.
Pain of varying strength during emptying of the bladder. Sensations extend not only to the genitals, but also to the abdomen.
Lack of feeling of natural, complete emptying of the bladder. Moreover, the patient can feel the presence of fluid in the organ even after next visit toilet.
Uncontrolled release of a small amount of urine, leakage during coughing, sneezing.
With severe stenosis of the urethral canal, the amount of urine is markedly reduced. In especially advanced cases, it can be released drop by drop, up to complete blockade natural outflow (obliteration of the urethra).
Blood discharge from the penis, which is observed regardless of the process of urination.
. In this case, the patient may be disturbed by partial sexual dysfunction.
The stream of urine becomes bifurcated, there is a spray of urine.

The disease is often accompanied by general malaise, weakness, loss of appetite and physical activity patients.

Diagnosis of urethral strictures

Identification of the presence of the disease in a man should begin with a visit to narrow specialist. He will ask the patient to voice complaints and list the symptoms that have manifested. Next, the following types of studies will be assigned:

. Allows you to identify the internal inflammatory process thanks to the assessment of the level of leukocytes, protein and red blood cells (erythrocytes). The study also makes it possible to detect pus and mucus in urine.
Sowing urine to identify bacteria and microorganisms. This study simultaneously determines the sensitivity to different kind antibiotics.
. The doctor performs the manipulation immediately after the act of urination. The amount of residual urine, the degree of deterioration in the functionality of the organ is determined.
Measurement of the specific flow rate of urine (or uroflowmetry). For its implementation, a special device uroflowmeter is used.
X-ray diagnostics. Allows you to determine the length of the urethra affected by stricture, its location, the presence of injured areas, stones. The contrast agent is delivered to the area under study in two ways: intravenously or directly through the opening in the penis (retrograde urethrography). intravenous method makes it possible to assess and photograph the state of the tissues of the bladder, the length of the narrowing, to analyze the work of the excretory organs.
Diagnosis through endoscopy. The introduction of an endoscope device into the affected organ will allow you to examine it from the inside, get to the narrowed areas and perform tissue sampling for biopsy.
Ultrasound of the kidneys. This is an additional study that the doctor prescribes to receive complete picture conditions of the urinary organs.

Treatment of urethral stricture

Treatment of urinary obstruction in men today is carried out in several ways. Each of them can be chosen by the attending physician after a thorough investigation of the problem. The determining factors are the length of scar areas, their localization and the degree of modification.

If the stricture has affected the bulbar urethra, and the length of the fibrous area does not exceed 1.5 cm, then an internal optical urethrotomy (or IU) is performed. This operation involves a longitudinal dissection of the urethra at the site of narrowing. In order for the manipulation to be effective, a complete incision of the spongiofibrosis to spongy body. HUA is indicated for those patients in whom urethral stricture has caused minimal spongiofibrosis. If a decrease in the modified area is noted during re-diagnosis, then it is advisable to repeat the optical urethrotomy.

Canal bougienage (expansion or dilatation). In progress surgical intervention the patient is injected with special dilators made of plastic or metal to increase the lumen in the urethra. Often, balloon-type catheters and a urethral clamp are used instead of rods. The tip in the form of a balloon is gradually inflated, stretching the scar area.

To avoid recurrence and re-education narrowing resort to the introduction of a urethral stent. This device regulates a sufficient distance between the walls of the urethral canal so that urine can flow through them.

If the pathology caused a complete retention of urine in bladder, then it is advisable to perform a cystostomy of the organ. A small incision is made in the bladder through which the surgeon passes a catheter tube. After surgery, urine will be drained through this device.
Laser treatment is considered an extreme measure, which involves excision and removal of the pathological tissue area, stitching together the resulting ends of the urethra. If the stricture has a maximum length, then after laser surgery there is a so-called "restoration" of the urethra. For the purpose of replacement, other healthy tissues of the patient are used.

Disease prevention

Prevention of the development of fibrous processes in the urethra is an important measure that every man should remember. Prevention, first of all, is a careful attitude to one's own health. If you have developed any disease in the genitourinary system (inflammatory or infectious nature), then in no case should you refuse a visit to the doctor and qualified treatment. Avoid any injury that can cause irreparable harm to men's health.