Urethra stricture
Contents:
Description:
Stricture of an urethra is called the pathological urethrostenosis which is caused by substitution of a normal mucous membrane and the spongy tissue of a spongy body of an urethra surrounding it with cicatricial fabric.
Urethra Stricture symptoms:
First, it is necessary to know that the SSU is a cause of infringement of bladder emptying, the second for frequency, or so-called infravesical obstruction at men, after a benign hyperplasia (DGPZh) or adenoma of a prostate. If the listed below symptoms of the broken outflow of urine take place at rather young man (to 40 㫅 years), then first of all it is necessary to suspect the SSU. If these phenomena take place at advanced age, it is necessary to think, first of all, of existence of DGPZh. It is possible to suspect existence of a stricture of an urethra and the SSU in the presence of the following signs:
Noticeable weakening of a stream of urine;
Reduction of volume of the produced urine for each urination;
Feeling of incomplete bladder emptying;
Need of long expectation before an urination and need to strain a stomach to urinate;
Spraying of a stream of urine;
Allocation of a significant amount of urine from an urethra after end of an urination;
Urodynia, discomfort at an urination;
Availability of impurity of blood in urine;
Pains in the bottom of a stomach;
Allocations from an urethra.
Quite often, urologists whom patients with similar complaints address make to patients wrong diagnoses of chronic prostatitis or a chronic urethritis and do not carry out full diagnosis for identification or an exception of the SSU. Therefore in the presence of these symptoms, it is better to address highly qualified specialists who are well formed and specially are engaged in diagnosis and treatment of the SSU.
Urethra Stricture reasons:
This substitution is a consequence of traumatic, chemical, radiation, infectious and inflammatory or thermal injury of an urethra. Because the stricture of an urethra is the hem which is not simply narrowing an urethra on site damaged its mucous, and a consequence of the complex pathological process including fibrosis of spongy tissue of spongy body and considerable deterioration in blood supply of the struck part of an urethra, this morbid condition in modern medical literature is called as the strikturny disease of an urethra (SDU).
Treatment of the Stricture of an urethra:
Historically the earliest methods of treatment which were applied in the Middle Ages were bougieurage of an urethra and an internal urethrotomy. Bougieurage of an urethra is called stretching, expanding, and at times and a breaking of the narrowed site of an urethra by means of a metal core with a smooth surface of various diameter (buzh). Despite improvement of a form and design buzhy, and also bougieurage very seldom cures use of the ointments which are slowing down formation of cicatricial fabric of SU. The matter is that increase in a gleam of an urethra by means of a buzh is temporary, as a rule, since does not liquidate actually main reason of the SSU — the broken blood supply of a zone of narrowing. In this regard in most cases after bougieurage of SU recur, becoming even more rough and extended. Thus, each subsequent bougieurage becomes even more difficult and only does a bigger harm. Same treats an internal urethrotomy. In the last decades, the internal urethrotomy is carried out under direct vision (via the cystoscope) and the internal optical urethrotomy is called. This procedure consists in a section of the narrowed site of an urethra and possesses all the bougieurage shortcomings described above, only not much more surpassing it in the frequency of a recurrence. In this regard now bougieurage of an urethra and an internal optical urethrotomy are recommended only at very short SU (length less than 0,5 cm) raspolozhnny in its bulbozny or bulbomembranozny departments. In other departments of an ureta bougieurage can применяься as an auxiliary method of treatment, and the optical urethrotomy is contraindicated. At the same time if after use of these methods there came the recurrence, their repeated use categorically is not recommended since practically from 100% probability will lead to a new recurrence and deterioration in a course of a disease — to formation longer and dense SU.
Installation of urethral stentait a special spring which is capable to hold the narrowed part of an urethra in rather expanded state and further to burgeon a mucous urethra. A lack of a method is frequent migration or shift of an urethral stent that sometimes causes serious complications. Now the method is applied extremely seldom.
In modern urology choice methods in treatment of narrowings of an urethra more than 1,0 cm long are plastic surgeries on substitution of the affected urethra healthy fabrics. If the stricture is located in perineal department of an urethra and its extent does not exceed 2 cm, operations of excision of a stricture within healthy tissues of an urethra and its sewing together "the end in the end" are carried out. At strictures of perineal department of an urethra 2 cm are longer, and also at any strictures of trailing department of an urethra operations of plastic substitution of a zone of a stricture are applied by own tissues of the patient (skin of a prepuce and a mucous membrane of a cheek is most often used). These operations provide elimination of SU and treatment of SATURDAY with efficiency higher than 85%. With their help it is possible to cure the patient who practically has no healthy urethra and a stricture is available on all its extent. Unfortunately, in our country technology of similar operations not all urologists and to most of patients, own the suffering SU, help of very poor quality is given. Aggravates a situation also that fact that some doctors do not aim to carry out to the patient from SU radical treatment which completely would fix a problem. Bougieurage of an urethra and an optical urethrotomy which recrudesce almost in 100% cases where as it is more favorable. They can be carried out many times, and the patient is forced to pay services of the doctor again and again.
