The urethral stricture in men is much more common than in women. This is due to the specific structure of the urogenital system. In a man, diseases of the genitourinary system require immediate treatment, since they can become a source of other pathological processes in the body.
What is this disease?
Doctors diagnose stricture in 50% of men over the age of 45.The disease can occur in a younger person. The presence of latent genito-urinary infections leads to its occurrence at a young age.
Stricture is a pathological narrowing of the urinary tract in men.
There is a disease due to growth in the lumen of the urethra of scar tissue. The walls of the urethra of a healthy person are lined with tender mucous tissue. But because of various factors, the mucosa can be damaged. Then, in place of the mucous membrane, a scar appears. Scar tissue is more dense and does not perform the functions of the mucous membrane. At the site of the scar there is a thickening that covers the urinary tract.
Classification of the disease and its form
Stricture can occur in a man during life, but in some cases babies are born with pathology. The main division of stricture in medicine is an innate and acquired form. The congenital form is surgically removed during the first hours of the infant's life. Men with a congenital form are prone to recurrence of stricture, as more often others suffer from urogenital infections.
The acquired form occurs in men in the process of vital activity and is divided into three forms:
- Initial stricture. There is damage to the mucous membrane of the urethra.
- The middle stage. The patient develops secondary pathologies. In the urinary tract, "sores" are formed, through which viruses and infections enter the body of a man.
- Severe form of stricture. A patient has a scar on the damaged area. In rare cases, the scar can completely cut off the urethral canal.
The stricture is divided into several forms, depending on the severity of the course of the disease and the location of the site. According to the characteristics of the disease, it is divided into congenital, traumatic and idiopathic. The idiopathic form of stricture has an unclear etiology, the causes of the pathology are not revealed. Doctors distinguish three forms of the disease: primary, recurrent and complicated. The recurrent form is most dangerous by its repetitions. The patient can tolerate up to three attacks of the disease for a year. A complex form has additional factors. A man may have fistulas or abscesses on the damaged portion of the urethral mucosa.
The disease is subdivided according to the localization of scar tissue. Prostatic and membranous forms are characterized by the presence of scar tissue in the posterior part of the urethral canal. Phenyual stricture occurs in men on the central part of the urinary tract. Bulbar and cephalic lesions are localized in the anterior part of the urethra, both forms are much more common in patients.
Stricture is classified by the area of the urethra. If the pathological process affects a smaller half of the area of the mucous membrane, then the stricture is called the subtotal. The total form affects almost the entire mucous tissue and covers most of the urethra. In rare cases, men are diagnosed with obliteration. This process completely blocks the urinary tract and urethral lumen, urination becomes impossible.
The disease can have a single and multiple form. With multiple forms, a man may have scarring in several areas of the urinary tract. Stricture is subdivided into a long, medium and short form. With a short form, the size of the scar can reach 1 cm. If the scar is larger than 2 cm, the stricture is long.
Symptoms
Symptoms of urethral narrowing are similar to other pathologies of the genitourinary system. A man can independently suspect the presence of stricture for the following symptoms:
- The urinary stream becomes smaller, the pressure of the jet decreases;
- In urine, there may be a mixture of purulent fluid or blood;
- After visiting the toilet, a person experiences a repeated urge to urinate;
- Severe low back pain when urinating;
- The urine stream splashes;
- In severe forms of the disease, the process of removing the liquid may be drip or completely absent;
- Ejaculation is very slow.
When collecting an anamnesis, men complain of frequent trips to the toilet. When urinating, the patient must stretch the muscles of the abdominal cavity and bladder. Some patients develop spontaneous urination. After visiting the toilet, there is a feeling of not emptying the bladder.
Symptomatic stricture is similar to prostate adenoma. If the patient does not turn to a specialist on time, and does self-treatment for prostatitis, severe consequences can occur.
Causes of the onset of the disease
With an inborn form of the disease, an intrauterine trauma or pathology of development is put. In adulthood, a man can get sick due to many factors. Stricture can occur in men due to inflammatory processes in the genitourinary system. Trauma of the urethra and blunt injuries of the genitourinary system are also the causes of the scar.
The formation of scar tissue of the urethral canal is affected by various chemical and thermal burns. Incorrect surgical intervention contributes to the appearance of the scar and the development of stricture. Men suffering from diabetes and atherosclerosis of blood vessels are at risk. Oncology of the genitourinary organs affects the development of pathology in the urethra.
Malicious effect of
disease. In the body of a man suffering from stricture, urine accumulation takes place. Since urine can not be completely removed from the body, it accumulates in the fold of the bladder. Stagnant urine has a high viscosity, has a high salt index. In severe forms of the disease, the patient may have sand in the bladder or form stones. Further treatment occurs only surgically.
Prolonged accumulation of urine in the bladder has a negative impact on the patient's kidneys.
A man can have hydronephrosis of kidney tissue. In advanced cases, a man is diagnosed with renal failure. Both pathologies are deadly to humans.
Diagnosis of pathology
If a variety of disorders are found during urination, a man should immediately contact a urologist. The specialist will conduct a thorough examination of the patient, will collect anamnesis. A man should tell about all the nuances in the genitourinary system. To diagnose a patient, a urinalysis test is taken. An extensive analysis will help to identify or exclude the presence of infectious diseases in the patient, pyuria or leukacyturia. A smear from the urethra will help to detect the presence of microorganisms on the mucous membrane of the urinary tract. Bacteriological examination of the identified microorganisms is necessary for the proper administration of drug therapy. Sowing will reveal the sensitivity of microbes to certain antibiotic agents.
The most important analysis for stricture in men is uroflowmetry. At this type of research, the man determines the speed and pressure of the urinary stream.
The patient is connected to the uroflowerometer. When urinating, the device calculates the average urinary rate. At the end of urination, the uroflowerometer issues a printout of the calculations. This method of research is very important for the establishment of many genito-urinary diseases.
An additional stage of the examination is cystometry or profilometry. Specialists conduct a cellular study of urinary fluid, reveal the cytology of scar tissue.
After uroflowmetry, a man undergoes ultrasound diagnostics. Ultrasound of the bladder is carried out after emptying. The study helps to identify the presence of residual fluid in the bladder. If there are more than 30 ml of fluid in the bladder, doctors talk about a complicated form of the disease in a man.
To determine the length and localization of stricture in a man, X-ray examination of the genitourinary system is performed. Radiography of the genitourinary sphere is different. The patient can carry out the following types of X-rays:
- Retrograde urethrographic examination;
- Multi-helical cystourethrographic method;
- Anterograde cystourethrography of the urinary duct.
All methods are administered in the urinary tract radiographic fluid. With a complete filling of all the urinary tract with fluid, the radiologist takes pictures. Radiologist conducts research together with a urologist. X-ray helps to fully reveal the picture of the pathological process in the urinary tract.
If a man suffers from a mild form of short stricture, then he has a dissection of the scar when taking the tissue for examination. Endoscopic method helps to study scar tissue on cytology. With complex forms of stricture, the scar is not cut.
Methods of treatment of pathology
Treatment should be carried out under the strict supervision of a specialist. Many men are embarrassed to tell the doctor about health problems and resort to independent treatment with herbs and biologically active supplements. Self-medication can bring an irreparable harm to the genitourinary system. Any intake of drugs should be carried out by the appointment of a urologist and coordinated with the therapist.
Several methods have been developed for the treatment of stricture:
- Stringing bougie;
- Optical urethrotomy;
- Stenting of the urethra;
- Urethroplastic intervention;
- Laser Therapy;
- Endoscopic procedure.
Busting stricture is carried out by inserting a metal tube into the male urethra. The metal tube helps to push the tissues of the urethral canal and increase the urinary duct. The method does not eliminate problems with tissue nutrition. After conducting the bougie, the patient may experience recurrence of the disease. The recurrent form with this method is very complicated. The stricture becomes longer and closes a larger area of the urethral canal. Secondary application of bougie is impossible, since further healing will not occur.
Optical urethrotomy is performed using a cystoscope. The damaged part of the urethra is exhausted. When the channel heals, relapses occur much less frequently than when bougying. Secondary conduction of optical urethrotomy is not carried out due to a lack of an operating field.
Stenting of the urethra is practically not used in modern urology. A urethral stent or a spring is placed in the canal of the urethra. A rare application of the operation is associated with a frequent displacement of the stent to the side. When the spring is displaced, the male may experience irreversible changes in the urethral canal.
The urethroplasty intervention showed the most positive changes in the organs of men. Urethroplasty consists in complete replacement of the tissue affected by stricture, with a healthy mucosa. Medindustria stepped far ahead. Tissues are grown artificially in the laboratory. The tissue substitute is used with a short stricture, the length of which does not reach 1 cm. If the stricture affects a large area, then donor tissue is used to replace it. Most often donor material is taken from the mucous membrane of the cheeks of a man or foreskin. In this method, 90% of men achieve positive results. The urethroplastic intervention allows to restore the urethra tissues even with complete defeat with stricture. After healing, the patient does not experience a relapse of the disease.
Laser therapy is carried out in almost all medical centers. The method is carried out by means of laser action on scar tissue. When using a laser, the scar tissue is completely burned out. On the site of stricture remains a small burn, which is treated with local ointments and solutions. The disadvantage of laser therapy is a recurring process. If the postoperative ointments and solutions are applied incorrectly or in a timely manner, a coarse scar may reappear on the burn site and the disease will return. The pathological process after laser therapy can occur with proper treatment. If the patient has increased epithelization in the body, the scar will be formed even with minimal surgical exposure.
The endoscopic method is used for the small development of stricture in a man. Endoscopic intervention is performed in all patients with stricture. To diagnose a disease, a man needs to take a piece of scar tissue for research. If, in radiography, a short stricture is detected in the patient, dissection of the scar tissue is performed with endoscopy. The operation gives temporary relief to the man and makes it easier to urinate and remove the residual fluid from the bladder.
Phytotherapy
It is impossible to cure this pathology using phytopreparations, but it is possible to significantly alleviate the patient's condition. To ease the symptoms of stricture, decoctions of herbs with a diuretic and anti-inflammatory effect are used.
To prepare the decoction, you must take in equal parts grass cowberry, chamomile, black elderberry leaves, poplar buds. The finished mixture must be crushed. It is necessary to take two tablespoons of the finished mixture and fill the floor with a liter of hot water. Infusion should be placed in a thermos and put in a dark place for eight hours. After that, the prepared broth should be taken at 30 ml before each meal. Treatment with decoction should not exceed ten days.
A good diuretic and anti-inflammatory effect is provided by a decoction prepared from cowberry, juniper fruit, St. John's wort and yarrow. The broth is prepared by the same method and is taken on an empty stomach in the morning for five days.
Treatment of stricture should be performed by a specialist-urologist. With proper examination and treatment, relapses do not occur in men.
