URETHRAL
STRICTURES
A
urethral stricture is a narrowing of the lumen of the urethra as a result of
scar tissue and contraction.
Common
causes of strictures are urethral injury (caused by in-sertion of surgical
instruments during transurethral surgery, in-dwelling catheters, or cystoscopic
procedures), straddle injuries, and injuries associated with automobile
crashes, untreated gon-orrheal urethritis, and congenital abnormalities.
The
patient reports that the force and volume of the urinary stream are diminished,
and symptoms of urinary infection and retention occur. Stricture causes urine
to back up, resulting in cystitis, prostatitis, and pyelonephritis.
An
important element of prevention is to treat all urethral infec-tions promptly.
Prolonged urethral catheter drainage should be avoided and the utmost care
taken in any type of instrumentation involving the urethra, including
catheterization.
Treatment
may include gradual dilation of the narrowed area (with metal sounds or
bougies) or surgery (internal urethrotomy). If the stricture prevents the
passage of a catheter, the urologist uses several small filiform bougies in
search of the opening. When one bougie passes beyond the stricture into the
bladder, it is fixed in place, and urine drains from the bladder. The opening
then can be dilated, bypassing a larger sound (a dilating instrument), with the
filiform then acting as a guide. After dilation, hot sitz baths and nonopioid
analgesic agents are administered to control pain. Antibiotic medications are
prescribed for several days after dilation to prevent infection.
Surgical
excision or urethroplasty may be necessary for severe cases. A suprapubic
cystostomy may be necessary in some pa-tients. Research studies using the diode
laser to treat urethral strictures suggest that it is safe and reliable,
especially as the first line of treatment (Kamal, 2001).
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