URETHRAL STRICTURE
A urethral stricture is a narrowing of the lumen of the urethra due to scar tissue and contraction:
Causes
Urethral injury (caused by insertion of surgical instruments during transurethral surgery indwelling catheters or cystospic procedures), straddle injuries and automobile accidents, untreated gonorrhoeal urethritis and congenital abnormalities
Signs and symptoms- Diminished urinary stream, symptoms of urinary infection and retention.
Stricture increases urine backs up cystitis, prostatitis and pyelonephritis.
Management
Palliative treatment gradual dilation of the narrowed area with metal sounds or bugies or operation under direct vision.
[If the stricture has become so small as to prevent the passage of a catheter, the urologist uses several small filiform bougies in search of the opening. When bougie passes beyond the stricture into the bladder, it is fixed in place and urine will drain from the bladder. The stricture then can be dilated to larger size by the passage of a larger sound (a dilating instrument) following behind the filiform as a guide, following dilation hot sitz baths and nonnarcotic analgesics are given to control pain. Antimicrobials are given for several days after dilation to minimize the infectious reaction thus lessening discomfort].
Surgical Excision or Urethroplasty may be necessary for severe cases sometimes a suprapubic cystostomy must be performed.
