Stricture Urethra – Causes, Symptoms & Diagnosis

What is Stricture Urethra?

The urethra’s main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury, or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.

The usual symptoms faced by such a patient are:

  • decreased force of micturition
  • narrowed/ thin urinary stream
  • straining to pass urine
  • sense of incomplete emptying

Common causes for stricture formation:

  • a history of previous catheterization or urethral procedure
  • trauma
  • past sexually transmitted infections such as gonorrhoea

This condition can easily be diagnosed by a few simple tests such as uroflowmetry and retrograde urethrogram

Symptoms of Stricture Urethra:

Urethral Stricture can cause numerous symptoms, and the most obvious sign is a weakened urinary system, which can vary from mild to severe. Some signs and symptoms of a urinary stricture include:

  • Weak urinary stream
  • Straining to pass urine
  • Frequent urine infections
  • Spraying of the urine system
  • Taking a long time to pass urine
  • Sense of incomplete bladder emptying
  • Frequent desire to pass urine owing to incomplete emptying

Some of the patients with severe urinary strictures are not able to urinate completely (acute urinary retention) and require immediate medical attention.
Urinary stricture can also cause prostatitis, a complicated urinary tract infection, in which the enlargement and inflammation of the prostate gland take place. Also, some patients develop secondary bladder stones because of incomplete emptying of the bladder.

Without treatment, urinary strictures can cause kidney infections and bladder stones, and it can also cause bladder enlargement, which may become dysfunctional with time. The selection of treatment for urinary strictures depends upon the severity and length of the stricture. Dr. Suraj Lunavat is one of the best urologists who provide Urethral Stricture Surgery in Pune.


Diagnosis:

Urethral Stricture Surgery Treatment in Pune, at Dr. Lunavat Urology Clinic, involves the latest treatments, interventions, and tests to detect the disease. Therefore, Dr. Suraj Lunavat can provide effective ways to manage and prevent this problem.

The diagnosis involves:

  • Physical examination
  • Cystoscopy
  • Urine flow test or uroflowmetry
  • Retrograde urethrogram and micturating cystourethrogram

For a safe and effective urethral stricture surgery, consult the certified and experienced urologist in Pune Dr. Suraj Lunavat.

Causes of urethral stricture:

In males during the urination process, the urine is carried out by the urethra from the bladder via the penis and is excreted from the urethral meatus. In urethral strictures, the male urethra becomes narrower in shape. The urethral stricture occurs due to chronic inflammation or the formation of scar tissue.

Reasons for the formation of scar tissue are as follows:

  • An injury to the scrotum, the penis, or a straddle injury
  • An infection that occurs mainly due to sexually transmitted diseases such as Chlamydia.
  • Use of instruments and catheters during surgery or examination of the bladder or urethra

The scar tissue narrowing the urethra causes difficulty in urinating. A weakened urinary system is the most obvious symptom of urethral strictures.

In severe stricture cases, patients are not able to urinate completely. This is an emergency medical condition known as urinary retention. Renal failure and hydronephrosis may also occur in long-standing cases. A urethral stricture causes inflammation and enlargement of the prostate

Therefore, internal urethrotomy is a safe and reliable process for the management of urethral strictures.

Dr. Suraj Lunavat, One of the best urologists in Pune, provides the best possible treatment for urethral strictures.

Benign Prostatic Hyperplasia: Causes, Risk Factors and Treatment

The prostate is a gland which is located beneath bladder of men that transports urine from the bladder out of penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow

Benign prostatic hyperplasia (BPH) or prostate gland enlargement is most common condition men older than 60 years of age. It causes uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems.

The cause of prostate enlargement is not entirely clear. However, it might be due to changes in the balance of sex hormones as men grow older.

Some of the risk factors of prostate enlargement includes:

  • Aging:  Most of the time it is observed in men older than 60.
  • Family history: Person with blood relative with prostate problems is more likely to have problems.
  • Diabetes and heart disease: Person with diabetes, as well as heart disease and use of beta blockers, that might increase the risk of BPH.
  • Lifestyle: Obesity increases the risk of BPH, while exercise can lower your risk.

Symptoms of Enlarged prostate

The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time.

Common signs and symptoms of BPH include:

  • Frequent or urgent need to urinate
  • Increased frequency of urination at night (nocturia)
  • Difficulty starting urination
  • Weak urine stream or a stream that stops and starts
  • Dribbling at the end of urination
  • Inability to completely empty the bladder

Less common signs and symptoms include:

  • Urinary tract infection
  • Inability to urinate
  • Blood in the urine

Complications of an enlarged prostate can include Sudden inability to urinate (urinary retention), Urinary tract infections (UTIs), Bladder stones, Bladder damage and sometimes Kidney damage

When to see urologist?

If you are facing urinary problems then you should discuss them with doctor. Even if you don’t find urinary symptoms bothersome, it’s important to identify or rule out any underlying causes. Untreated, urinary problems might lead to obstruction of the urinary tract.

Dr. Suraj Lunavat, One of the best urologist in Pune, provides best possible treatment for prostate enlargement including medications and prostate laser surgery. To choose the best option, first he test the size of prostate, other health conditions you might have and patient’s preferences. He is one of the best doctor for prostate enlargement in Pune.

ELIMINATE KIDNEY STONES WITH PCNL

PCNL Treatment
Percutaneous nephrolithotomy (PCNL) is a mildly invasive surgery for removing kidney stones. Classically stones more than 2 cm in size are removed through this procedure. However, with modernization and miniaturization of instruments, stones as small as 1cm in size can be removed through mini PCNL or ultra-mini PCNL.
What are the indications of undergoing a PCNL?

PCNL is required if: –

  1. A patient has a large stone burden (classically more than 2 cm). At times the entire kidney is filled with branched stones (staghorn calculus), or if there are multiple large stones in all calyces of the kidney.
  2. In cases of stones which have not been fragmented after ESWL (Extracorporeal Shock Wave Lithotripsy).
  3. Stones in locations of the kidney which are not suitable for removal using flexible ureteroscope, i.e. RIRS (Retrograde Intra-Renal Surgery).
  4. In certain cases of malformed kidneys such as horseshoe kidney where one can attempt a laparoscopic-assisted PCNL.

What are the advantages of PCNL over an open surgery for stone removal?

  1. Avoidance of a large skin incision which in turn is cosmetically better.
  2. Experience less post-operative pain
  3. Earlier resumption of normal diet
  4. Early ambulation of the patient
  5. Early recovery and hence early return to work/normal activities.

What are the contra-indications to doing a PCNL?

This surgery is not advised in certain conditions such as: –

  1. If there is urinary tract infection. A sterile urine culture is a pre-requisite to this surgery. In case of documented urine infection, the patient needs to be treated with antibiotics and a urine culture repeated to confirm the absence of infection.
  2. Patients who are on blood thinners, in such cases, the medicines need to be stopped for 7-10 days in consultation with the physician who prescribed them.
  3. This procedure is not done for pregnant patients because of the fluoroscopy (X-ray exposure) involved.

What preparations does a patient undergo before this surgery?

  1. Before undergoing this surgery your urologist will order radiological investigations to determine the presence, number, and location of stones in the kidney. This provides him with an important road-map to plan the surgery most importantly the site of puncture into the kidney which is the most important step to establish a tract from the skin into the kidney. An IVP (intravenous pyelogram), an NCCT (a non-contrast CT scan) and an X-ray KUB can be helpful in this regard.
  2. A few blood tests will be required to assess patients’ fitness for surgery both from the urologist and the anesthetist’s point of view. This includes: –
    • Kidney function tests
    • Liver function tests
    • Complete hemogram
    • Bleeding and clotting profiles
    • Viral markers (HBsAg, anti-HCV, HIV I and II)
    • Urine culture (a test to find out urinary tract infections)
    • Chest X-ray
    • ECG3
  3. If patient is a smoker, the doctor advises stopping smoking at least a week or two before the procedure.
  4. Patients are instructed to stop the consumption of certain medications due to various reasons.
  5. Patients are usually admitted on the day of surgery with overnight fasting.

What are the precautions to be taken after discharge?
• In most cases after discharge, the recovery is uneventful.
• Some patients have a little pain in the back while passing urine.
• For the initial 2-3 days, urine may be slightly reddish/pinkish.
• Patients are advised to take a bath every day.
• In case of fever/shivering or passing dark red-colored urine they should contact their treating urologist immediately.
• Patients are advised to refrain from exercises/heavy physical activities for a period of 4 to 6 weeks post-surgery.

What are the known complications of this surgery?

In experienced hands, this minimally invasive surgery is very safe. However, all surgical procedures carry some risk. In the case of PCNL the following complications can occur: –

  1. Inability to access the stone/establish a tract from the skin to the stone inside the kidney. In such scenarios, the surgery may have to be converted to an open approach for removal of stones.
  2. Infection and sepsis
  3. Possible injury to blood vessels inside the kidney leading to bleeding. This at times necessitates blood transfusion.
  4. Formation of arterio-venous fistulas post surgery leading to delayed bleeding. This has to be corrected by angioembolization.
  5. Injury to other intra-abdominal organs such as lungs, colon, liver, spleen, stomach, etc.

Evaluating the Signs of an Enlarged Prostate

Enlarged Prostate Treatments

Signs and the requirement for treatment change with each man’s enlarged prostate also called benign prostatic hyperplasia. And every method has its advantages and dangers. These factors must be considered as you decide how to treat your BPH signs.

 

Your Quality of Life With an Enlarged Prostate

If your enlarged prostate signs are soft and not annoying, there’s possibly no need for treatment. 1/3 of men with soft BPH find that their signs clear up without treatment. They may just watch and wait.

However, when enlarged prostate signs are annoying or are influencing your quality of life or overall health, it’s time to talk to your physician about the treatment choices. Together you will decide if you would profit most from medication, a minimally invasive procedure, or surgery.

It’s essential to speak with a doctor when you start noticing differences in the urinary role. You need to Know what’s going on so you can be treated for an enlarged prostate if needed. For many men, particularly those who are young when the prostate begins building, getting early treatment can head off difficulties later on.

 

Evaluating the Signs of an Enlarged Prostate

To help your doctor know how annoying enlarged prostate signs are for you, the American Urological Association (AUA) has developed a BPH Symptom Index. This is a brief survey that asks about specific signs and how often they occur. Each answer is assigned a number — and your total is placed on a scale varying from mild to critical.

A score of 0 to 7 is considered a mild sign score; 8 or over is considered easy to critical.

The AUA suggests the next treatment for enlarged prostate based on the hardness of signs:

Mild signs that don’t hurt you (AUA score 0 to 7): If you are not disturbed by your signs, and they don’t change your regular life, prepared to wait is the best choice for you. You should get routine checkups to make sure that you are not producing difficulties.

Mild to critical signs (AUA score of 8 or more): If you are not disturbed by your signs, you may choose prepared waiting. However, if your signs do begin to interfere, you may take medication, a minimally invasive method, or operation.

Mild to critical signs (AUA score of 8 or more) with complications: If signs are annoying and you have increased difficulties such as disability to urinate, you may require a catheter, surgery, or other methods.