Urethroplasty

Urethral Stricture is a narrowing of the part or whole of the urethra due to Injury or Urinary Tract Infection.

Causes

  • Injury to the urethra mostly due to Vehicals.
  • Bacterial infection of Urinary tract
  • Sexually transmitted Diseases (STD)
  • Instrumentation of the Urethra
  • Passage of the large kidney stone through urethra can cause urethral stricture
  • BXO (Balanitis Xarotica Oblitarance) it’s a white skin disease cause stricture of whole urethra

Symptoms

  • Thin stream of urine
  • Decrease force of urinary stream
  • Intermittent Urination
  • Incomplete empting of urination
  • Sometimes retention of urinary bladder
  • Symptoms due to back pressure to the kidneys (Hydronephrosis –Pain in loin)

Treatment

Intial diagnosis is done with uroflowmmetry & sonography of Kidney Urinary & bladder. If Uroflowmetry reports shows obstructive uroflow pattern then RGU Retrograde Urethrogram) is advised to the patient.

In RGU contrast dye is injected into the urethra and X-Ray is taken.

It’s a radiological investigation. By RGU X-ray we can know the location of stricture in the urethra and length of the uerethra.

Most common location of stricture is bulbus urethra.

Endoscopy treatment

VIU (Visual Internal Urethromy) is done when stricture is treated at bulbous urethra.

It’s a not a definitive treatment for stricture urethra because in most of cases repeated VIU treatment is required. Ultimately it leads to high cost to the patient.

For this reasons all the patients are explained & counseled for CIC

Self Clean Intermittent Cathetarization) after VIU Treatment.

CIC helps in further requirement of VIU treatment for stricture urethra.

Now because of better compliance most of patients are now ready for CIC treatment and they are benefited as far as cost of the repeated VIU treatment and follow up examination.

Urethroplasty

Indication

  • Short bulbous stricture (1cm or 1.5cm long) End-to-End urethroplasty gives the best result in this type of stricture. Patient has very good flow of the urine after urethroplasty. Patient gets permanent results and in most of the patient CIC is not required.
  • Orandi’s urethroplasty for stricture in distal urethra (Penile Urethra)
  • BXO causing pan urethral stricture.

BXO is white skin disease of the penis which effect the glans prepuce or urethra.

Buccal Mucosal Urethroplasty is now commonly done for adult who are having PAN urethral stricture cause by BXO.

In this surgery Buccal Mucosal (Mouth) Graft is taken and sutured to the cut open part of Stricture urethra over the Foley’s urethral catheter. It’s a major surgery.