A 55 Y gentleman presented with recurrent urethral stricture after multiple sessions of VIU (endoscopic incision of stricture segments). The stricture was panurethral measuring about 12 cm in length as measured by flexible cystoscopy. Ramayyapramila hospital is the pioneer of MEMOKATH insertion in AP and has the largest series till date in the state.
Urethral stricture is an abnormal narrowing of the urethra (the tube that releases urine from the body).
Causes, incidence, and risk factors
The most common cause of anterior urethral stricture is infections.Sexually transmitted diseases can cause infection of the urethral glands(for ex.Bulbo-urethral glands) and resultant inflammation and fibrosis of the region
Other common causes are Balanitis Xerotica Obliterans/lichen sclerosis which can lead to stricture of the whole urethra(pan urethral stricture).This disease usually involves the glans,meatus and the penile pendular urethra.Usually shrunken atrophic glans with meatal narrowing with whitish patches are found on the glans The involvement due to Lichen Sclerosis can be more proximal on the penile skin and pendulous urethra, which is more common than previously thought. Although penile skin may appear normal, microscopic involvement may be present. Moreover it is known that endoscopic manipulation of meatus involved with Lichen Sclerosis also has a potential of disseminating the disease into proximal urethra causing pan-urethral stricture
The trauma either direct because saddle injury or pelvic trauma incurred during the road traffic accidents can cause anterior and posterior urethral injuries and stricture respectively.
The instrumentation (traumatic or repeated) can also lead to trauma. The carcinoma bladder patients who undergo repeated intervention are more prone. Also prostatic enlargement patients who undergo endoscopic prostatectomies are also prone for stricture especially if the gland size is big because the dwelling time of the instruments inside body will be higher in such cases.This will also make urethra more prone for instrumentation leading to stricture.
1)dysuria, weak interrupted stream,urgency,urge incontinence,frequency
2)Recurrent Urinary Tract Infections
4)Retention of the urine
6)Renal function deterioration
Signs and Tests
A physical examination may reveal the following:
1) Hardness (induration) on the under surface of the penis
2) Whitish Patches on glans,meatal narrowing,shrinkage and atrophy of the glans indicative of Balanitis Xerotica Obliterans
3) Sometimes urethrocutaneous fistula can be found
4) Evidence of pelvic fracture/scars of previous Supra Pubic Catheter placement can also be found.
Sometimes the exam reveals no abnormalities:
Tests include the following:
1) Urinary flow rate
2) Post-void residual (PVR) measurement
3) Urinalysis /Urine culture
4) Tests for chlamydia and gonorrhea
5) A retrograde urethrogram to confirm diagnosis
MEMOKATH STENT INSERTION:
|MEMOKATH IN PLACE IN URETHRA|
|memokath stent loading device|
|stent being inserted under fluoroscopic guidance|