The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture. Show What Happens under Normal Conditions?The bladder empties through the urethra and out of the body (called voiding). The female urethra is much shorter than the male's. In males, urine must travel a longer distance from the bladder through the penis. In males, the first 1" to 2" of the urethra that urine passes through is called the posterior urethra. The posterior urethra includes:
Strictures that happen in the first 1" to 2" of the urethra that urine passes through are called posterior strictures. In males, the final 9" to 10" of the urethra is called the anterior urethra. The anterior urethra includes:
Strictures that happen in the last 9" to 10" of the urethra that urine passes through are called anterior strictures. Men are more likely to have a urethral disease or injury because of their longer urethra. For this reason, strictures are more common in men. They are rare in women and in infants. Stricture (narrowing of the urethra) can happen at any point from the bladder
to the tip of the penis. This narrowing restricts or slows the flow of urine in. Some common causes are: In most cases, no cause can be found. In adults, urethral strictures are most often due to: See More See Less Posterior Urethral StricturePosterior urethral strictures happen in the first 1" to 2" of the urethra. This kind of stricture is due to an injury linked to a pelvic fracture (e.g., motor vehicle or industrial accident). In these cases the urethra is disrupted, or completely cut and separated. Urine cannot pass. A catheter must be placed either through the abdomen into the bladder (suprapubic tube), or through the penis into the bladder. This lets urine drain until the stricture can be fixed. Anterior Urethral StrictureAnterior urethral strictures happen in last 9" to 10" of the urethra. This kind of stricture is caused by:
Simply put, the urethra is like a garden hose. When there is a kink or narrowing along the hose, no matter how short or long, the flow is reduced. When a
stricture is narrow enough to decrease urine flow, you will have symptoms. Problems with urinating, UTIs, and swelling or infections of the prostate may occur. Severe blockage that lasts a long time can damage the kidneys. Some signs are: There are several tests to determine if you have a urethral stricture including: The doctor gently places a small, bendable, lubricated scope ( a small viewing instrument) into the urethra. It is moved up to the
stricture. This lets the doctor see the narrowed area. This is done in the office and helps your doctor decide how to treat the stricture. This test is used to see how many strictures there are, and their position, length and severity. This is done as an outpatient X-ray procedure. Retrograde in this case means "against the flow" of urine. Contrast dye (fluid that can be seen on an X-ray) is inserted into the urethra at the tip of the penis. No needles or
catheters are used. The dye lets the doctor see the entire urethra and outlines the narrowed area. It can be combined with an antegrade urethrogram (antegrade means "with the flow" of urine). Dye inserted from below fills the urethra up to the injured area. Dye inserted from above fills the bladder and the urethra down to the stricture. These tests together let the doctor find the gap to plan for surgery. Also, if you have trauma to the urethra, you may have this X-ray
procedure after emergency treatment. Contrast dye can be injected through the catheter that was placed for healing. There are many options depending on the size of the blockage and how much scar tissue is involved. Treatments
include: dilation – enlarging the stricture with gradual stretching urethrotomy – cutting the stricture with a laser or knife through a scope open surgery – surgical removal of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty) There are no available drugs to help treat strictures. Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and
stones could develop. Also, there is a risk of urinary retention (when you can't pass urine), which could lead to an enlarged bladder and kidney problems. This is usually performed in the urologist's office with local anesthesia. The stricture is stretched using larger and larger dilators called "sounds." A special balloon on a catheter can also stretch the tissue. But this stretching is not really a cure and needs to be repeated
regularly. If the stricture comes back too quickly, you may be taught how to insert a catheter from time to time to prevent it from coming back. Side effects include bleeding and infection. Sometimes a "false passage" or second urethral channel may form from the stretching. This uses a special scope that is moved along the urethra until the stricture is found. A knife blade or laser at the end of the cystoscope is used to
cut the stricture and create a gap. A catheter may be placed into the urethra to hold the gap open and let it heal. The suggested time to leave a catheter tube draining is based on the length of the stricture. Many reconstructive procedures have been used to treat strictures, and some involve 1 or 2 operations. In all cases, the choice of repair is based on the location and length of the stricture and how serious it is. No
single repair is right for all cases. The 2 main types are anastomotic urethroplasty and substitution urethroplasty. Anastomotic Urethroplasty This method is usually reserved for short urethral strictures. In this case, a cut is made between the scrotum and rectum. The urethra can then be reconnected after removing the stricture. This is usually performed as an outpatient procedure or with a short hospital stay. A small, soft
catheter is left in the penis for 10 to 21 days. It is then removed after an X-ray is taken to make sure the repair has healed. Substitution Urethroplasty When the stricture is long, tissue can be transferred to replace the section that had the stricture. In difficult cases, substitution repairs may need to be done in stages. These repairs should be done by a urologist experienced with these surgeries. Overall the success rates are very good. The 3 kinds of
substitution procedures are: Free Graft This method replaces or enlarges a section of the urethra using your own tissue. The tissue may be skin (taken from the shaft of the penis) or, more often, buccal mucosa (taken from inside the cheek). After surgery, you may need a short hospital stay and use a catheter for 2 or 3 weeks. Skin Flap With this surgery, flaps of skin are rotated from the penis to create the new
section of the urethra. This is needed when a graft needs to be long, and the stricture is severe. These procedures are complex and should be done by a surgeon with plastic surgery experience. After surgery, you may need a short hospital stay and use a catheter for 2 or 3 weeks. Staged This method is used when local tissue will not work for a free graft or a skin flap.
Because urethral strictures can come back after surgery, you should be followed by a urologist. After the catheter is removed, your doctor will want to check you with physical exams and X-rays as needed. Sometimes the doctor performs urethroscopy to check the repair. In some patients, the stricture may return but may not need additional treatment. But if it causes obstruction, it can be treated with urethrotomy or
dilation. Repeat open surgery may be needed for serious strictures that come back. Explore Further
Urology Health extraRead the latest issue of Urology Health extra, the Urology Care Foundations patient-focused magazine. What is it called when they put a tube in your urethra?Cystoscopy (sis-TOS-kuh-pee) is a procedure that allows your doctor to examine the lining of your bladder and the tube that carries urine out of your body (urethra). A hollow tube (cystoscope) equipped with a lens is inserted into your urethra and slowly advanced into your bladder.
What is the process of inserting a catheter called?The procedure to insert a catheter is called catheterization.
What is catheterization of urinary bladder?In urinary catheterization, a catheter (hollow tube) is inserted into the bladder to drain or collect urine. There are two main types of urinary catheterization: indwelling catheterization and clean intermittent catheterization (CIC). Indwelling catheterization.
What is the insertion of a tube into the bladder?Cystostomy. A cystostomy is a surgical procedure where a doctor inserts a small tube into your bladder through the skin of the lower abdomen. The tube allows urine to drain from your bladder into a bag outside your body.
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