Friday, January 29, 2021

Frequently asked questions about urethral narrowing

Frequently asked questions about urethral narrowing

What are the symptoms of urethral narrowing?

Typical symptoms of a urethral constriction are a thin, weak, possibly split urine stream, a prolonged micturition time (total time required to urinate) and dripping of urine.

The speed at which urine is released when urinating can be determined with a urine flow measurement (uroflowmetry). The flow rate normally shows a bell-shaped curve: the flow of urine increases continuously in the first third of the micturition time and then continuously decreases again.

Normal maximum flow rates are at least 15 milliliters per second. In contrast, the profile of urine flow velocity in urethral constrictions lacks the bell shape - it remains practically flat and flow velocities of less than 10 milliliters per second are achieved.

The symptoms of urethral narrowing are often progressive, meaning that they become more pronounced over time. At an advanced stage, the bladder can no longer be completely emptied and the urge to urinate will soon return after urination.

Frequent urinary tract infections and weakening of the bladder muscles can then occur as complications of the residual urine in the bladder. The extreme consequence of an untreated, progressive urethral stricture is complete urinary retention with severe consequences for the kidneys.

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Is a urethral narrowing congenital?

In rare cases, a constriction of the urethra is congenital - but then it is usually diagnosed in childhood. It is very unlikely that congenital urethral constriction will not cause problems until later in life. (Ironically, however, surgical correction of congenital urethral constriction can later become the cause of acquired urethral constriction.)

Urethral constrictions in adults are generally the result of healing or inflammation of the urethral lining. These have led to the formation of scar tissue, which now narrows the cross-section of the urethra.

About 30% of urethral constrictions are the result of accidental injuries. This includes pelvic fractures, but also bruises in the area of ​​the perineum and genital organs. If the structure becomes noticeable, the causal accident is sometimes long forgotten.

Historically, urethral constrictions were typically associated with inflammation of the urethral mucosa as a result of bacterial infections caused by sexually transmitted pathogens (gonorrhea, chlamydia, etc.). This cause is still responsible for around 20% of all urethral strictures today. A rare autoimmune skin disease (lichen sclerosis) causes about 5% of all strictures.

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Can a urethral narrowing be treated without surgery?

Yes: With so-called bougienage (urethral stretching), the scarred constriction is mechanically stretched by inserting elastic plastic rods into the urethra. This treatment can be carried out on an outpatient basis; in principle, patients could even do it at home.

But: The result of urethral bougienage is generally very short-lived, improvements hardly last longer than a month. The procedure would have to take place again and again at regular intervals - and the treatment almost inevitably leads to a worsening of the symptoms. This is due to the fact that with every bougienage the smallest injuries occur in the problematic scar tissue, which stimulates it to grow faster and further.

Stricture patients who are healthy enough to be anesthetized are therefore advised not to use bougienage - sooner or later, surgery will be necessary anyway, and bougienage only complicates the initial situation.

The most promising methods of treating urethral strictures today are end-to-end anastomosis and urethral plastic surgery: open interventions in which the scarred mucous membrane tissue is completely removed.

How long is a hospital stay with a urethral narrowing?

How long you have to stay in the hospital for the surgical correction of a urethral narrowing depends on the procedure to be performed.

  • An endoscopically performed urethral slit only requires a short hospital stay of usually one to two days. Some urologo cdmx urologists even offer outpatient procedures.
  • Open interventions (urethroplasty, end-to-end anastomosis) are more complex and require a hospital stay of at least five days.

After these interventions, an indwelling catheter with a urine bag is placed for the healing phase to relieve the ureter mucous membrane. After a urethral slit, this catheter remains in the urethra for a few days, after a urethral plastic surgery for one to two weeks.

Does the surgical treatment of urethral narrowing cause pain?

As with any invasive procedure, postoperative pain occurs after surgery to treat urethral strictures. This is to be expected during the healing phase and can be controlled with suitable pain relievers.

Many patients who have had an oral mucosal urethral plastic surgery also describe the postoperative pain in the mouth as more uncomfortable than that in the perineal area, where the incision is made for the open procedure.

After urethral surgery, long-term or chronic pain can unfortunately also occur. The literature reports about pain in the perineal area and pain during orgasm. The corresponding studies are only small, however, so statements on the frequency of these complications are not very reliable; Often one finds information on the order of 30%. (Nonetheless, over 90% of the patients in the cited studies were all in all very satisfied with the result of their urethral surgery.)

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