Urethroplasty is the surgery done to treat Urethral stricture, which is a condition caused due to the narrow passage of lumen of the urethra. Due to the blockage caused due to the narrowing down, the flow of the urine may be blocked partly or entirely. Urethral stricture is more common in males than in females. In Urethral stricture, the bulbar urethra is the part that is generally affected.
Stricture is narrow in the urine pipe, the urine pipe starts from the bladder, and it goes all the way up to the tip from where the urine is discharged. So if there is any narrowing in the region below the prostate and up to the tip, that entity is known as a stricture of the urethra. In stricture urethra, the patient is present with the main symptom of passing urine in thin streams, passing urine with a lot of force. He has to actually push a lot of force to pass the urine. Sometimes the patient complains of passing the urine drop. And in extreme cases, The patient can come up with the complaint of complete retention of the urine that is the inability to pass a single drop of urine from the urine pipe. And in those cases, the urine is diverted in an emergency and later, the various ways of treating stricture are discussed with the patient. So stricture urethra is very common in the present scenario because of various instrumentation. The patient has to undergo either the surgery of the prostate or in surgery of a bladder stone even for the ureteric stone.
Another cause of a stricture urethra is urethral injury, in the form of a road traffic accident or any injury to the perineum, which leads to damage of the blood supply in one of the particular region, either the bulb or in the region of the prostate and the bulb leading to damage to the urine pipe or complete disruption of urine pipe.
Urethral stricture is most commonly caused due to the presence of inflammation in the tissues or the presence of scar tissues. The main causes of developing scar tissues are:
Urethral Stricture can be asymptomatic, i.e. have no symptoms at all, reaching to mild symptoms, like urinal retention. Here are the few signs of Urethral Symptoms :
Some males have a higher tendency of developing the condition of Urethral Stricture given to the following risk factors that may develop:
The urethral stricture treatment is done via several different ways mentioned below depending upon the severity of the urethral stricture. The treatment of urethral stricture depends upon the length and the severity of it and it varies from person to person.
1) Firstly an ultrasound is done to see how much urine the patient is able to pass in an act of micturition.
2) Then uroflowmetry is done and graphical presentation of the urine flow of the patient is done.
3) And the third thing which is done is retrograde urethrogram, in which contrast or a die is passed from the tip of the urine pipe and it goes all the way up to the bladder. An X-ray is taken to see where exactly the stricture is, how long the stricture is, and how thin the stricture is.
Some of the treatments for urethral stricture are listed below:
In this kind of Urethral Stricture Treatment, the urethra is widened using medical equipment known as a dilator. The surgeon passes small wiring through the urethra passage leading towards the bladder where the dilation begins. Larger dilators are used to make increase the narrowing. Another nonsurgical option for Urethral Stricture Treatment is permanent urinary catheter placement. This procedure is carried out when the condition of the urethral stricture is very critical and the risks are also very serious.
Urethroplasty Surgery is a surgical type of treatment done to treat several urethral strictures. The surgeon makes an incision after employing anaesthesia. Direct vision internal urethrotomy is an endoscopic procedure whereby an endoscope is inserted into the urethra to see the stricture. The surgeon uses a small knife which is passed through the endoscope. The knife makes a cut in the affected area, i.e. urethral stricture, and widens the urethral opening. Their urethra is then reconstructed. This methods of Urethroplasty is therefore also called, Urethral reconstruction surgery.
In this type of treatment, due to the blocked passage of urine, sometimes urinary diversion is needed. The flow of the urine is permanently rerouted to an opening in the abdomen. A small part of the intestines is used as a medium to connect the ureters to the urethral opening. Urinary flow diversion is carried out when the bladder has become dysfunctional and needs a powerful treatment before any more harm to the body is caused.
In the past various endoscopic treatments were used in the form of cutting the stricture or directing the stricture or using lasers to open the stricture. But, when the studies have been done on the failure rate, it is almost 80 to 90% or a period of 4 to 5 years. So most of the patients who come to us with stricture urethra, we always tell them, the best option or the best treatment with the best result is open surgery which is known as urethroplasty.
So there are various types of urethroplasty which can be done. If the stricture is, because of the instrumentation or infection and it is present from tip to the prostatic region or the proximal bulb, this area is known as a bulb. So in this case, we have to assess how long the stricture is, and how dense the stricture is. And accordingly, we can decide whether we have to go with one side buccal. Because in this, we have to use various grafts either from the buccal mucosa or from the skin or from the skin behind the ear. We can use the skin patch or the buccal mucosa patch to widen up this urine pipe. And then, we just distinct on to the surface and so the pipe becomes larger then the patient can have a good urine flow.
If its a traumatic stricture leading to complete disruption or complete blockage of the urine pipe, then the treatment is done by removing that scar or the bad tissue and then joining the two normal ends. This procedure is known as anastomotic urethroplasty. The results are very good if done by a skilled reconstructive urologist at a centre which is dealing with the good number of stricture urethra or urethral injury.
Patients with the problem of urethral stricture usually have this question, whether the urethroplasty will have any impact on sexual desire or sexual liability or not?
So, for their clarification, urethroplasty is the treatment of urine pipe only and the erection part is dealt with the corpus cavernosum and which remains intact, we don’t touch that. So the patient retains his ability to have a normal erection and they can live a normal sexual life post urethroplasty. And they can father a child and there will be no issue related to erectile dysfunction or infertility.
Urethroplasty is one of the safest to treat urethral stricture with a success rate in the range between 85 to 90 per cent at the centres which are doing a higher volume of this surgery.
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Stricture urethra, as it was considered in the past as a non-treatable disease or problem is again a false notion. The success rate with the urethroplasty is very high and patients can live a normal life without any dilatation or instrumentation in the future with the help of urethroplasty.
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