Stricture and obliteration of the urethra ( urethritis) - Causes, Symptoms and Treatment .MF .
stricture and obliteration of the urethra - a scarring of the urethra wall, which occurs due to acute urinary retention in the bladder lumen.In its origin urethral stricture divided into congenital and acquired, and the latter can be traumatic, inflammatory and iatrogenic etiology.
Causes of stricture and obliteration of the urethra
Naturally, the exact cause of congenital narrowings of the urethra called impossible.She, like many other causes of genetic defects, to this day remains unknown.
As for acquired strictures, they have many reasons raznooobraznyh.Firstly, it is an inflammatory disease of the urethra - urethritis.They may have different etiology, but most often are the consequence of stricture gonoreynyh urethritis.
Post-traumatic urethral stricture may vznikat after open or closed urethral injuries.The most common mechanism of injury similar in men and boys meet in the fall to the bicycle frame or otkrytyyu manhole cover.Thereafter, as a rule, it arises traumatic
Under iatrogenic urethral stricture involve narrowing that occurs due to non-professional vmeshatelstva doctor.Most often, this statement of metal urethral catheter, which has certain technical difficulties.If incorrect technique can damage the lining of the urethra, which then formed fibrous tissue, which can cause obliteoatsii urethra.Therefore, when such manipulation on the urethra, you must be extremely careful and attentive.
Symptoms stricture and obliteration of the urethra
clinical picture of the disease depends on the degree of narrowing of the urethra.As a rule, the pathology develops gradually.In the initial stages of the patients concerned about the feeling of incomplete emptying of the bladder and heaviness in the very act of urination.Over time, the symptoms progress, and urine flow becomes thinner and thinner.Patients slowly begins to accumulate large amounts of urine in the bladder, which is no longer goes through the urethra, due to stricture of the latter.
Against the background of such a chronic course of disease exacerbation can occur, which are caused by alcohol, spicy food or exercise.This condition is referred to as a syndrome of acute urinary retention.It manifests complete absence of diuresis (urination), swelling and tenderness of the sharp lower abdomen.
Against this background, there is a common and symptoms that manifests weakness, malaise, disturbance of sleep and appetite.
If there is a patient one of the above symptoms it requires immediate consultation of the urologist, because the earlier the disease is detected, the better it can be treated.
Diagnostics stricture and obliteration of the urethra
A specific method for diagnosing narrowing of the urethra can be considered urethrography.The method consists in the introduction of contrast medium into the cavity of the urethra, followed by X-rays, which gives clear information about the latest terrain.Urethrography may be downward, upward and backward.
Downward methodology for conducting such a study lies in the intravenous administration of water-soluble contrast, which is excreted by the kidneys.Radiography of the urethra in such a situation may give information about at which level begins narrowing of the urethra from the bladder.
To find out how passable the urethra from the outside, it is necessary to conduct a retrograde or ascending urethrography.The method consists in the introduction of contrast in external urethral opening using a syringe.
Sometimes, to determine treatment strategies determine only a narrowing of the border is not enough, so patients or performed total counter urethrography.It is the joint implementation of the above two methods.At the same time, to X-ray clearly defined portion of the urethra free of contrast.That he is the cause of the clinical symptoms and requires surgical correction.
Total urethrography.The arrows indicate urethral stricture
Among other informative techniques in relation to the diagnosis of strictures and the obliteration of the urethra can be called ultrasound.It can be run as a conventional sensor, and rectal.It is the latter makes it possible to detect abnormalities in the distal urethra.
Treatment of stricture and obliteration of the urethra
Treatment of the disease can be operative or conservative.Typically, in the initial stages or the first time to see a doctor, patients want to limit ourselves to conservative treatments.Among these techniques, primarily, we can distinguish bougienage urethra are MDM is to introduce into the urethra of metal wires of different diameters which increase along its Mete, expand the lumen of the urethra.
good effect observed with a combination of bougienage enzyme therapy, which consists in the use of such drugs as lidasa or ronidaza that have the ability to resorption of scarring of the urethra mucosa.These drugs are introduced into the cavity before introduction channel mochesipuskatelnogo bougie passed.
In addition, some experts recommend to be administered before probing hormones such as hydrocortisone, which are very well reduce inflammation and analgesic procedure.
worth noting that probing is performed only under local anesthesia, as it is a very painful procedure.For pain in the urethra cavity injected gel preparation lidocaine or Novocain, which is produced in special bottles.
If conservative treatment was neefektivnym to correct stricture and obliteration of the urethra is used surgery.It usually is modified urethral resection portion and stitching the ends of the urethra.If you own tissues is not enough, then use urethral prosthesis with an artificial graft.
Treatment folk remedies
Almost all patients with urethral strictures who initially sought help from traditional healers, soon found themselves at a reception at the urologist.As a rule, all the funds that are recommended by traditional healers, are not only effective, but soon cause disease progression.As practice shows, healers throw up their hands at the very moment when the people most in need of assistance.During AUR they can not evacuate her from the bladder and is simply forced to recommend to address to the urologist.Unfortunately, many patients still do not understand this and continue to use traditional remedies under various urinary problems of sexual health.
rehabilitation after illness
The main task after surgery is to avoid suppurative inflammation of the postoperative wound.To do this, first of all, you need to avoid urinary streaks in the incision area.This can only be achieved formulation of a urethral catheter.However, such a procedure could face other complications, such as cystitis.Therefore, patients must learn to treat urethral catheter, constantly introducing antiseptic solution into the cavity of the bladder and tube changing about once a week.
for speedy wound healing and the formation of a smaller scar, which can lead to relapse of the disease, physiotherapy is used in the form of magnetic therapy, diathermy and galvanization.
Feeding habits and way of life
Because the strictures of the urethra there is a tendency to stagnation of urine in the bladder lumen, this leads to more urinary stress on the kidneys, which threatens to stone formation or deposition of sand.Therefore, patients who are diagnosed stricture or obliteration of the urethra, you must stick to a diet number 7. This is the power of alcohol restriction fatty foods, hot spices, marinades, and other substances that may lead to an increase in daily urine.
Complications of stricture and obliteration of the urethra
pathogenesis of complications of this disease is based primarily on the stagnation of urine in the cavity of the bladder and renal pelvis.This creates good conditions for the reproduction of pathogenic microorganisms, and very often the stricture of the urethra complicated pyelonephritis.Clinically it is manifested by fever and the appearance of acute pain in the lumbar region against the background of previous symptoms.
Another complication caused by the same cause, is nephrolithiasis.If at first it is only a little sand deposition in the cavity of the renal pelvis and cups, then in the later stages where you can see and calculi (stones).
Danger urolithiasis when urethral strictures is that it is very difficult to conservative treatment, because the narrowing of the urethra is a direct obstacle to the discharge of stones from the bladder.
Prevention stricture and obliteration of the urethra
As is known, in order to prevent any of the diseases, you need to avoid those factors that lead to it.When urethral strictures is primarily an inflammatory disease of the body.The reasons that lead to them, are known.It hypothermia, trauma and uncontrolled sexual relations that lead to infection of the external genitalia.In principle, if these risk factors will be able to rule out the disease with a stricture of the urethra can not meet.And if they could not be avoided, it is important to time to see a specialist in order to prevent progression of the disease.
Ed.urologist Astashin EE