URETHRAL STENOSIS

It is the narrowing of the canal that carries the urine from the bladder to the outside.

It is a rare disease that requires a team that is very specialised in these pathologies in order to achieve good results, according to the Ministry of Health, which also recognises a series of benchmark centres for the management of these diseases.

Our Unit offers a team of renowned prestige and experience in this field, led by Dr. Javier Romero-Otero.

The male urethra has classically been divided into two areas, and these in turn have subdivisions:

  • Anterior urethra: navicular fossa, pendulum or penile urethra and bulbar urethra.
  • Posterior urethra: membranous urethra (sphincter), prostatic urethra and bladder neck.

Urethral stenosis is described as the decrease in the diameter of the urethral lumen, which hinders urine output from the bladder to the outside. This process consists of the formation of a fibrous scar that affects the epithelium lining the urethra (urothelium) and the corpus spongiosum. Normally, when we talk about urethral stenosis, we refer to the anterior urethra.

The causes of urethral stenosis are varied:

  • Traumatic.
  • Iatrogenic, as a result of medical procedures such as catheterisation, endoscopic procedures such as cystoscopy, surgery, etc.
  • Infectious: urethritis, sexually transmitted diseases.
  • Lichen sclerosus or balanitis xerotica obliterans: is an autoimmune disease of unknown cause, with genetic predisposition. It has been connected to radiotherapy, burns, infections, hormonal disorders, etc. The lichen causes white lesions on the mucosa and loss of elasticity of the tissues. It mainly affects the glans, the foreskin (producing phimosis) and the navicular fossa. Urethral involvement is rare although, in recent years, its frequency has increased.

Urethral stenosis produces obstructive symptoms of the urinary tract, consisting of a split weak stream, prolonged micturition time and incomplete emptying of the bladder. Some patients may have erectile dysfunction, difficulty with ejaculation and recurrent urinary tract infections. All this can alter the patient’s quality of life and cause psychological problems.

  • Super-specialised urologist in urethral pathology.
  • Flowmetry.
  • Flexible and compact cystoscope.
  • Flexible and compact ureterorenoscope.
  • Radiology: urethrocystography, CT, NMR.

Diagnosis is carried out based on the symptoms and with the help of diagnostic tests:

  • 1 – Flowmetry: micturition flow is measured.
  • 2 – Urethroscopy: an endoscope is used to look inside the urethra in order to observe the narrowed areas and the appearance of the mucosa.
  • 3 – Retrograde and voiding urethrography: the bladder is filled with a contrast agent introduced through the urinary meatus. X-rays of the urethra are taken during bladder filling and voiding. It is possible to observe the number of stenoses, their length and location.
  • 4 – Urethral calibration: to evaluate the diameter of the stenosis.
  • Urethrotome
  • Termino-terminal urethroplasties
  • Urethroplasties with graft
  • Creation of neourethras
  • Microsurgical instrumentation
  • Surgical microscope.

There are several options for the treatment of stenoses.

  • Urethral dilation consists in progressively introducing thicker dilators or bougies into the urethra to dilate the narrowed areas. It is a mitigation action that does not solve the problem, but can improve the symptoms. It should be carried out periodically since the effects are temporary.
  • Internal urethrotomy consists in sectioning or cutting the narrowed area via endoscopy (from inside the urethra and under vision). It can be performed with laser or cold cutting. Stenosis reappearance percentage is very high, between 58-84%. It is usually performed in single short stenoses (under 1 cm) without previous treatment.
  • Termino-terminal urethroplasty consists in removing the affected area of urethral mucosa and re-suturing the mucosa ends. It is performed on stenoses smaller than 2 cm.

For longer stenoses, a technique called urethroplasty with graft or flap interposition is used. This procedure may be carried out in a single surgery or in two. The stenosis is removed and the affected urethral mucosa area is replaced by another tissue. Many types of grafts have been used, but in recent years, the use of the patient’s oral mucosa has become popular, achieving good results.

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