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Endoscopic treatment of urethral strictures |
The urethral scalpel is used for a clean incision of tissues is a well developed method for the incision of soft tissues like the urethra, the liver and intestine. This enables the development of a thin layer of fibroblasts which leads to a smooth healing and reduces the possibility of recurrence of the disease.
Urethral narrowing is called urethral stricture. This develops in any segment of the male or female urethra. it is mostly observed in the male. It develops from traumatic injuries, inflammatory disease or after urethral surgery. The treatment is to widen the urethra through its incision whether with a special sharp instrument or using the energy of laser.
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Healthy urethra
Note the regular wide lumen and the widened area at the end of the urethra
U urethra
Urethral narrowing (stricture)
Note the narrow area usually at the hind (postrior) part of the urethra
U urethra
St stricture
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Who qualifies for the operation?
People who have a narrow urethra. This is observed when the urinary stream is week. The narrow urethra results in residual urine may be with super added infection. This should be avoided or treated by the incision of the narrow area.
How does the operation work?
The patient lies on the back. The urethra is inspected endoscopicaly and its caliber is measured. The narrow segment is then incised using the the urethral knife. The bladder is then inspected. A catheter is inserted for a day.
If the stricture is too narrow and is difficult to define, then a ureteric catheter is inserted to guide the way to the bladder. as a safety measure.
Healing:
It is a simple procedure. Healing is smooth within 2-3 days. In very rare cases where bleeding may occur, a compression bandage for 1 day well solve the problem.
How to prepare for the operation?
Please read the chapter on preparation of the patient.
Frequently asked questions (FAQ):
- How does a stricture develop?
The development of fibrous tissue as a result of traumatic or inflammatory injury leads to the development of the stricture.
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- What are the symptoms of stricture?
These are a weak urinary stream and lower abdominal pain. The signs are residual urine, urinary infection or late effects on the kidneys.
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- Does stricture and its treatment affect the potency?
No.
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- What are the complications of the stricture?
Narrowing of the urethra leads to the development of a high pressure in the bladder which may affect the kidneys through the transport of this pressure thought he ureters upside. It also leads to the development of residual urine and consequently urinary infection.
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- What are the advantages of the incision of the stricture ?
The incision is a controlled process where the tissues are cut under vision in a straight line with a simultaneous coagulation of the cut blood vessels. This leads to a near blood free operation. The incision will be covered by a thin layer of fibroblasts which give rise to a smooth healing. The recurrence rate is then expected to be less in comparison to the conventional methods.
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- Does stricture repeat?
Yes, and then it is always narrower and more difficult to treat.
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- Could all strictures be treated using the laser incision?
No, recurrent strictures and very narrow long strictures should be treated by open surgery
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