Strictures and obliteration of the urethra( urethra) - Causes, symptoms and treatment. MF.

Strictures and obliteration of the urethra are cicatricial changes in the urethral wall, which cause an acute retention of urine in the bladder cavity. In their origin, strictures of the urethra are divided into congenital and acquired, and the latter can be traumatic, inflammatory and iatrogenic etiology.

Urethral stricture

Causes of stricture and obliteration of the urethra

Naturally, the exact cause of congenital narrowing of the urethra can not be called. It, like the causes of many other genetic defects, remains unknown until today.

As for the acquired strictures, they have many different reasons. First, it is inflammatory diseases of the urethra - urethritis. They may have different etiologies, but most often strictures are a consequence of gonorrheal urethritis.

Post-traumatic strictures of the urethra may occur after open or closed urethral injuries. Most often, a similar mechanism of injury in men and boys occurs when they fall onto a bicycle frame or an open lid of a sewer hatch. After that, as a rule, there is a traumatic urethritis, which is resolved by the formation of a large amount of granulation tissue in the lumen of the urethra, which also blocks the outflow of urine.

Under the iatrogenic stricture of the urethra is meant a constriction that results from unprofessional interventions of the doctor. Most often, this is the setting of a metal urethral catheter, which has certain technical difficulties. With the wrong technique, the mucous membrane of the urethra can be damaged, where a fibrous tissue is then formed, which can cause the urethra of the urethra. Therefore, with such manipulations on the urethra, it is necessary to be extremely cautious and attentive.

Symptoms of strictures and obliteration of the urethra

The clinical picture of the disease depends on the degree of narrowing of the urethra. As a rule, pathology develops gradually. At the initial stages of patients, the feeling of incomplete emptying of the bladder and the severity during the act of urination itself disturb. Over time, the symptoms progress, and the urine stream becomes thinner and thinner. Patients slowly begin to accumulate a large amount of urine in the bladder, which no longer leaves the urethra, due to the stricture of the latter.

Against the backdrop of such a chronic course, there may be exacerbations of pathology, which are caused by the use of alcohol, spicy foods or physical exertion. This condition is called acute urinary retention syndrome. It manifests itself in the complete absence of diuresis( urination), swelling and sharp soreness of the lower abdomen.

Against this background, there is a general symptomatology, which is manifested by weakness, malaise, disturbance of appetite and sleep.

If a patient has one of the above symptoms, he needs an immediate consultation with the urologist, since the earlier the disease is identified, the better it is treatable.

Diagnosis of strictures and obliteration of the urethra

Urethrography can be considered a specific method of diagnosing urethral narrowing. The method consists in the introduction of a contrast agent into the urethral cavity followed by an X-ray study that provides clear information about the patency of the latter. The urethrography can be descending, ascending and counter.

The descending technique of conducting such a study is to intravenously introduce a water-soluble contrast that is secreted by the kidneys. X-ray of the urethra in such a situation can give information on the level at which the urethra narrowing begins from the side of the bladder.

In order to find out how passable the urethra is from the outside, it is necessary to carry out retrograde or ascending urethrography. The technique consists in introducing contrast into the external opening of the urethra by means of a syringe.

Sometimes, in order to determine the tactics of treatment, clarifying only one narrowing line is not enough, so patients undergo total or collateral urethrography. It consists in the joint implementation of the two above methods. At the same time, the urethra site, which is free from contrast, is clearly defined on the radiography. It is he who is the cause of clinical symptoms and needs surgical correction.

Total urethrography. Arrows indicate urethral stricture

Among other informative techniques for the diagnosis of strictures and obliteration of the urethra can be called ultrasound. It can be performed by either a conventional sensor or a rectal one. It is the latter that makes it possible to identify pathology in the distal parts of the urethra.

Treatment of strictures and obliteration of the urethra

Treatment of this disease can be operative or conservative. As a rule, at the initial stages or at the first visit to the doctor, patients want to confine themselves to conservative methods of treatment. Among these methods, in the first place, it is possible to single out bougie urethra, the essence of which consists in the introduction into the urethra of metallic conductors of different diameters, which, in accordance with their increase, widen the lumen of the urethra.

A good effect is observed when the bougie is combined with enzyme therapy, which consists in the use of drugs such as lidase or ronidase, which have the ability to resolve cicatricial changes in the mucous membrane of the urethra. These drugs are introduced into the cavity of the mocheispuskatelnogo channel before the introduction of bougie.

In addition, some experts recommend the introduction before the bougie hormone preparations such as hydrocortisone, which very well relieve inflammation and anesthetize the procedure.

It should be noted that the bougie is carried out only under local anesthesia, since it is a very painful procedure. For anesthesia, a gel preparation of lidocaine or Novocain is introduced into the urethral cavity, which is available in special vials.

If conservative treatment is not effective, surgical intervention is used to correct strictures and obliteration of the urethra. It, as a rule, consists in a resection of the changed site of a urethra with the subsequent stitching of the ends of the urethra. If your own tissues are not enough, then using the prosthesis of the urethra with an artificial shunt.

Treatment with folk remedies

Almost all patients with strictures of the urethra, who at first applied for help to folk healers, soon found themselves at a urologist's reception. As a rule, all those drugs that are recommended by traditional healers are not only ineffective, but soon lead to the progression of the disease. As practice shows, healers drop their hands exactly at the moment when the person most needs help. During an acute urinary retention, they can not evacuate it from the bladder in any way and are simply forced to recommend contacting the urologist. Unfortunately, many patients still do not understand this and continue to use folk remedies for certain problems of urinary and sexual health.

Rehabilitation after

The most important task after surgery is to avoid purulent inflammation of the postoperative wound. For this, first of all, it is necessary to avoid urinary leakage in the area of ​​the surgical suture. This can be achieved only by setting the urethral catheter. However, such a procedure may threaten other complications, such as cystitis. Therefore, patients need to learn how to properly care for the urethral catheter, constantly injecting into the bladder cavity solutions of antiseptics and changing the tube about once a week.

For faster healing of the wound and the formation of a smaller scar that can lead to relapse of the disease, physiotherapeutic treatment in the form of magnetotherapy, diathermy and galvanization is used.

Features of diet and lifestyle

Since urethral stricture tends to stagnate in the bladder cavity, this leads to an additional urinary load on the kidneys, which threatens the formation of stones or the deposition of sand. Therefore, patients who are diagnosed with strictures or obliteration of the urethra should follow the diet number 7. This diet is limited to alcohol, fatty foods, spices, pickles and other substances that can lead to an increase in daily diuresis. Complications of strictures and obliterations of the urethra

The pathogenesis of the complications of this disease is based, first of all, on the stagnation of urine in the bladder cavity and renal pelvis. This creates good conditions for the reproduction of pathogenic microflora and very often urethral stricture is complicated by pyelonephritis. Clinically, this is manifested by an increase in body temperature and the appearance of acute pain in the lumbar region against the background of previous symptoms.

Another complication caused by the same cause is renal stone disease. If in the beginning it consists only in an insignificant deposition of sand in the cavity of the renal pelvis and calyx, then in the later stages, stones( stones) can be seen there.

The risk of urolithiasis with urethral strictures is that it is very poorly susceptible to conservative treatment, since the narrowed urethra is a direct obstruction to the escape of stones from the bladder.

Prevention of strictures and obliteration of the urethra

It is known that in order to prevent any of the diseases, it is necessary to avoid the factors that lead to it. In the stricture of the urethra it is, above all, the inflammatory diseases of this organ. The reasons that lead to them are known. This is hypothermia, trauma and uncontrolled sexual relations, which lead to infection of the external genitalia. In principle, if these risk factors can be excluded, then with such a disease as the stricture of the urethra can not be met. And if they could not be avoided, it is important to turn to a specialist in time to prevent the progression of the disease.

Rev.doctor urologist Astashin Е.Е.