Urethra is a tube that carries urine from the bladder so as to expel it. The urethra normally remains wide enough so as to allow the urine to seamlessly flow through it. Urethral stricture is a condition when the flow of urine is impeded because of the narrowing of the urethra. Mostly men are affected by this ailment.
Urethral stricture is mainly caused due to the inflammation of the tissues or because of the presence of scar tissues. Scar tissues may develop due to a number of reasons. If a man has undergone endoscopy whereby an instrument is inserted into the urethra, he is at risk of developing scar tissues. Other causes are cancer of urethra or prostate, radiation therapy, sexually transmitted infections, trauma or injury to the pelvis or urethra, long-term use of catheter to drain the urinary bladder and an enlarged prostate. Men who have had suffered from sexually transmitted infections, had a recent catheter placement, had urethritis due to infection and an enlarged prostate are at the highest risk of developing this condition.
The treatment for urethral stricture requires the widening of the urethra. It can be done non-surgically by means of a dilator. Surgical procedure in the form of open urethroplasty can also be done to treat this condition. A complete urinary diversion procedure may also be done.
The non-surgical mode of treatment requires the use of medical instrument called a dilator to make the urethra wider. This is mostly a simple procedure that does not require a patient to get admitted to any hospital as it is an outpatient procedure. A small wire is passed through the urethra and into the bladder. This process helps to dilate the urethra. The width of the urethra gradually increases with the continued use of the large dilators. Another non-surgical method that is used to treat severe cases of urethral stricture is the permanent urinary catheter replacement.
There are no medications to treat urethral stricture. This condition does not go away easily and surgery is generally recommended for people with urethral symptomatic strictures. Direct vision internal urethrotomy is an endoscopic procedure whereby an endoscope is inserted into the urethra to see the stricture. Then a tiny knife is passed through the endoscope to cut the stricture and widen the urethra. Open urethroplasty reconstructs the urethra after the removal of the tissues. Another procedure to treat this condition is the urinary diversion procedure. The flow of the urine is permanently rerouted to an opening in the abdomen. Part of the intestine is used to connect the ureters to the opening. This procedure is generally done when if the bladder is severely damaged or if it is to be removed.
A person suffering from urethral stricture may experience a number of symptoms like decreased urine steam, difficulty or experience of pain during urinating, frequent urge for urination, incomplete emptying the bladder and urinary tract infection. A person experiencing some or most of these symptoms is eligible for treatment. A doctor will review a patient’s medical history, perform a thorough physical examination and even one or more tests on a patient to determine whether he is suffering from the condition. A person will be eligible after he has been diagnosed by a doctor.
People who do not have severe urethral strictures are generally not eligible for treatment. A person not experiencing any of the symptoms associated with urethral stricture is not eligible for treatment. Some of the tests that may help a doctor to understand whether a person has urethral stricture or not are measuring of rate of flow of urine, cystoscopy, measuring the size of the urethral opening, analyzing the physical and chemical properties of urine to find out if there is bacteria and tests for Chlamydia and gonorrhea. A person will not be eligible for treatment if the doctor does not diagnose him after performing these tests.
Urethral dilation can make the stricture worse over a certain period of time. The side-effects of direct vision internal urethrotomy are pain, bleeding, erectile dysfunction, urinary tract infection and even recurrent stricture. The risks associated with open urethroplasty are infection, bleeding, recurrent stricture, pain and fistula and dribbling after urination. Urinary diversion surgery has its fair share of complications as well.
A person who has undergone surgery to treat urethral stricture will require a few weeks time before he can resume his normal physical activities. It is always useful to follow the doctor’s advice. After a surgery, a catheter is left for about a week. In some other cases, a suprapubic tube is also left in addition to the catheter.
The time required for a person to recover from a surgery for urethral stricture depends on a number of factors like which procedure has been performed, how long the catheter has been kept in place, the overall health status of the patient and even on the preference of the physician. Procedures like urethroplasty require a longer recovery period while other procedures like internal urethroplasty and dilation are generally outpatient procedures.
The cost of urethroplasty surgery in India can vary in between Rs 1,90,000 to Rs 3,22,000. Repeat urethrotomy and dilation to treat urinary stricture can cost more than Rs 5 lakhs.
Urethral stricture can be treated successfully if a doctor can identify the most appropriate initial treatment strategy. A proper treatment strategy will help to reduce the recurrence of this condition. A person who has undergone treatment should take extra care while using catheters and instrumentation so as to avoid developing this condition again. However, the results are not permanent as a person may develop this aiment as a result of some injury or disease.
Clematis is a homeopathic treatment that helps to cure urethral stricture in the initial stages. Another homoeopathic medicine used to treat people who have difficulty in passing urine is the Chimaphila. Other homoeopathic medications that help to deal with the symptoms of urethral stricture are cantharis, thiosinaminum, conium, arnica and others.