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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