Prostatitis --Urethral Strictures


Causes of Prostatitis
Do Urethral Strictures cause Chronic Prostatitis?
Urologists frequently consider whether prostatitis patients have urethral strictures, or narrowings, that are causing their symptoms. If there is a stricture, and it is repaired, and it is the only thing going on, repair should end your prostatitis pain and problems. However many patients report having stricture repair procedures, without relieving them of their prostatitis pain and problems. Exactly how often this happens is impossible for a patient group to say.
The following text explains the concepts involved in urethral strictures. The text was anonymously posted on the newsgroup sci.med.prostate.prostatitis....we don't know the source. —Webmaster
Urethral Stricture A fairly common disorder among men is acquired urethral stricture, in which the urethra is narrowed, usually from infection or trauma. Pathologically, the urethral opening becomes narrowed by a buildup of fibrotic tissue. The resulting stricture of the urethral opening hampers the excretion of urine.
There are also several complications that can result from urethral stricture. One of the more common complications is prostatitis (inflammation of the prostate). Hypertrophy (excessive enlargement) of the bladder muscle may occur and reduce voiding ability. If urethral stricture is severe and continues over a long period of time kidney failure may result. Additional urinary tract complications have also been reported.
The first sign of urinary stricture is usually a noticeable diminution of urinary stream. Thus, urinary stream measurement is one of the initial diagnostic procedures. This is done by recording the volume of five-second collections of urine from the mid-stream when the rate of urinary flow is at maximum. This procedure is repeated over several days until about 10 urine samples have been collected. The samples are averaged and if the flow rate is found to be under 10 ml/sec this indicates a significant decrease of urine flow. If infection is suspected the urine is cultured for bacterial analysis. X-ray studies are done to determine the location and extent of the urethral stricture.
Additional information can be obtained through urethroscopy(cystoscopy), a procedure that permits direct visualization of the lesion. However, if the urethra is very narrowed it will not be possible to pass the urethroscope through the fibrotic area. Prostate obstruction produces symptoms similar to those of urethral stricture, so the prostate should be examined as well. Another possible diagnosis is urethral cancer, although primary cancer of the urethra is rare. If cancer is present urethroscopy reveals irregularly shaped lesions. The diagnosis can be confirmed by histological analysis of a biopsy sample.
There are several options for treating urethral stricture. Dilation is usually considered a temporary measure. It is achieved by passing increasingly wider filiforms (threadlike instruments) through the urethra to expand the opening until a catheter can be inserted or with Van Buren sounds (rods with curved ends that insert into the uretha).
Although dilation enlarges the urethral opening rescarring usually narrows the urethra again. It is usually reserved for cases where the stricture is so severe it causes chronic urine retention. Pain and bleeding are the main problems associated with dilation procedures. The urologist performing dilation must be careful to avoid urethral perforation.
Permanent cure of urethral stricture usually is achieved with urethrotomy. This technique is performed under direct vision by inserting an endoscope with a sharp knife on the end into the urethra. The urologist looks through the endoscope and uses the knife to cut the fibrotic tissue narrowing the urethral opening. Success rates of 70 to 80 percent with few complications have been reported. If necessary the procedure can be repeated.
If urethotomy fails to correct the problem of urethral stricture the alternative is open surgery. The procedure of choice depends on the length of the urethra affected. In cases where shorter lengths of urethra are involved (1.5 cm or less) the affected part of the urethra is cut out and the cut ends are anastamosed (joined together). If a segment of urethra greater than 2 cm is involved a skin graft technique called patch graft urethroplasty is used. Preferably, the skin to be grafted is taken from the penis. The urethra is cut lengthwise through the fibrotic area and the skin graft is placed on the opening to form a widened tube. In cases of stricture where a very long segment of urethra is involved the entire length of narrowed urethra is removed and a skin graft formed into a tube is surgically inserted to replace it.
Because urethral strictures can recur within one year of therapy, the patient should be followed up in this period.

This information is forwarded to you by the Prostatitis Foundation. We do not provide medical advice. We distribute literature and information relevant to prostatitis. While we encourage all research we do not endorse any doctor, medicine or treatment protocol. Consult with your own physician.
© 2002 The Prostatitis Foundation
	Further Contact:(click on words or mailbox) This page was created by Ideasmith®. Add to this site

Causes of Prostatitis

Do Urethral Strictures cause Chronic Prostatitis?