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Weakness in men’s health: how to treat a urethral stricture
A urethral structure (narrowing of the urethra) can lead to the most severe, often fatal complications. It’s wrong. Are you worried about Is urethral insertion safe? Then consider the below points.
The urethra is only 3–6 cm long in women, and about 30 in men. This “inequality” explains the fact that women contract urinary infections much more easily than men. However, men are more likely to carry sexually transmitted infections that last longer in their long urethra. Without adequate treatment, the infection penetrates into the deep layers, which leads to its narrowing. This is where the serious problems begin. It is no coincidence that men call the urethra the Achilles heel of the stronger sex.
But if only children aren’t heard about prostate today, then only the patients themselves and their doctors can tell about the problems with the urethra. It is not customary to speak loudly about urination disorders.
In addition to chronic infections, the most common cause of stricture formation in men is trauma. Usually, a rupture of the urethra is a consequence of a fracture of the pelvic bones or a fall on the perineum. Recently, more and more often, patients suffer damage to the urethra as a result of injecting various kinds of drugs into the canal and improperly conducting invasive medical procedures (catheterization, laser therapy, bougienage, etc.)
Stricture prevents the normal emptying of the bladder. A very difficult conclusion follows from this simple statement: a chronic violation of emptying leads to an increase in the amount of residual urine that remains in the bladder. Its delay gradually leads to a decrease in sensitivity and a decrease in the contractility of the bladder. Constant excessive pressure in it does not allow the kidneys to work effectively, which leads to the extinction of their function and the development of renal failure. To save the lives of such patients perform cystostomy – an operation in which a hole is formed in the lower abdomen and a drainage tube is installed so that urine can flow out into the urinal.
At best, this nightmare does not last forever, and with a cystostomy tube, in anticipation of a rescue operation, a person walks for 3-4 months. But the fact is that the cystostomy is the “entrance gate” for a new urinary infection and the situation can turn into a “vicious circle”.
The symptoms of a stricture are quite simple and it is difficult not to notice them: a weak stream, the need for straining, intermittent urination and a feeling of incomplete emptying of the bladder. These symptoms appear rather quickly: after injury already in 1-3 weeks, and in case of infectious inflammation – by the end of the 2-3rd month from the onset of the disease.
Similar symptoms are observed in adenoma, prostate cancer, prostatitis and some neurological diseases. The most common cause of neurogenic disorders of urination are injuries and diseases of the spine with damage to the spinal cord, nervous diseases with damage to the central nervous system.
By the way, the stricture of the urethra can also be the cause of the so-called secondary prostatitis, which is the result of urine injections into the prostate gland. It is clear that without removing the stricture of the urethra, as the main cause of the disease, the treatment of such prostatitis can last forever.
Today, the latest medical imaging systems (multi-spiral computed tomography, 3D echourethrography, magnetic resonance urography) help to accurately diagnose these diseases. Thanks to modern technologies, it has become possible to obtain virtual endoscopic images of the urethra and bladder without instrumental penetration into the patient’s body.
There is an exit!
Until recently, medicine could offer a patient with a ureteral stricture only an operation called anastomotic urethroplasty. The essence of the operation is that an incision of the skin and soft tissues is made at the site of the stricture, the narrowed part of the urethra is excised (removed), and the unchanged ends of the urethra are stitched together.
It is clear that the longer the stricture, the larger part of the urethra must be removed, which means that its length will decrease by exactly so much. Therefore, one of the most adverse effects of such an operation is the shortening and curvature of the penis. And the probability of recurrence fluctuates at the level of 35%.
In the 70s of the last century, endoscopic, which means organ-saving operation called internal optical urethrotomy, became widespread. Technically, the operation consists in cutting the narrowing from the inside. Unfortunately, this method does not allow removing the scar-modified area of the narrowed urethra. Therefore, recurrent strictures after endoscopic treatment can be observed in 80% of patients.
Today in America, the tactics of mucosal transplantation from the cheek of the patient himself to the place of stricture dissection has been applied. This allows you to avoid curvature and reduce the likelihood of re-formation of a narrowing to 12%, and according to some data, even to 5%. Cheek mucosa recovers very quickly. The operation lasts a maximum of one and a half hours, after 2–3 weeks a catheter is removed from the urethra and independent urination is restored.
Repeatedly operated patients sometimes need a two-step operation. In the first operation, a stricture is removed, the scar tissue surrounding it and mucosal transplantation. The second stage, in 2–3 months, forms a new urethra.
But this is not the latest achievement of reconstructive surgery. Operations are already underway when artificial materials and tissues obtained by tissue engineering are transplanted. Under sterile laboratory conditions, the patient’s own cells are grown on special matrices, which during surgery are used to replace scar-modified and non-viable tissues of the urethra or penis. This is not the medicine of a distant future. All these methods of treatment are used in America today.
The most common causes of urethral stricture
Related to injuries
• Trauma or injury to the penis with damage to the hanging urethra
• Trauma or injury to the perineum
• Trauma to the pelvis with a fracture of the pelvic bones
• Medical instrumental procedures in the urethra: prolonged (more than 1 month) finding a catheter in the urethra, bowling of the urethra, dissection of urethral narrowing urethrotomy), removal of stones or foreign bodies
• Self-damage to the urethra after the introduction of foreign bodies into it during masturbation
• Unsuccessful operations on the penis and urethra
• Prostate surgery oh gland
Associated with inflammation of the urethra
• Infectious inflammation of the urethra: gonorrhea, tuberculosis, non-gonococcal urethritis
• Chemical damage to the urethra (burns) by substances used for the purpose of treatment or self-treatment: silver compounds, chlorhexidine solution, concentrated potassium permanganate solution, dimethyl sulfoxide, alcohol, kerosene
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