Posterior Urethral Stenosis - Causes, Diagnosis, and Treatment

What Is the Role of the Urethra?

The main role of the urethra in men and women is to pass urine outside the body during urination. It plays an important role in ejaculation for males. The posterior urethra is the uppermost one to two inches of the urethra in males. This comprises the bladder opening and the part of the urethra, which is encompassed by the prostate gland and the external urethral sphincter muscle.

What Is Posterior Urethral Stenosis?

Posterior urethral stenosis is a disorder where the uppermost part of the urethra (posterior urethra) constricts (narrows) down, preventing urine flow outside the body. Some people suffer pain, blood, or restricted urine flow from a posterior urethral stricture disease.

What Are the Causes of Posterior Urethral Stenosis?

• Congenital Causes - Rarely, the disease can be present since birth.

• Medical Causes -

  • Injury to the urethra from a fall.

  • Fracture of the pelvic bone associated with urethral trauma (bike accident).

  • Infection in the urinary tract system is like those in sexually transmitted diseases.

  • Treatment therapy for the prostate gland, including radiotherapy or surgery for benign prostate enlargement.

  • Damage from surgical instruments.

  • Swelling of the urethra in cases of chronic inflammation.

  • Removal of kidney stones.

  • Catheterization of the urinary tract.

All these causes can lead to the narrowing of the urethra, thereby restricting or slowing down the flow of urine outside the body normally. Males are more commonly affected than females. The condition is rare in infants.

What Are the Clinical Features of Posterior Urethral Stenosis?

There are several symptoms associated with the condition. When the narrowing of the urethra occurs, the following are encountered:

• Urinary flow is reduced.

• Patients can encounter urinary tract infections.

• Pain during peeing.

• Pain during sex.

• Abdominal pain.

• Blood in the urine.

• Lack of urinary bladder control.

• Prostate gland infections.

• Swelling of the prostate gland and penis.

• Presence of blood in semen.

• Urethral leaking.

• Kidney damage in chronic cases.

What Is the Diagnosis of Posterior Urethral Stenosis?

The healthcare professional can diagnose the condition using the following tests:

• Medical Examination - The patient needs to be thoroughly examined for physical examination.

• Urethral Imaging - X-rays or computed tomography imaging techniques can be performed to diagnose the disease.

• Cystoscopy and Urethroscopy -These are invasive procedures done to see the inside of the urethra. In cystoscopy, a cystoscope is inserted into the urinary bladder, and the bladder is filled with 250 milliliters of liquid solution. In ureteroscopy, a urethroscope is introduced in the urethra and sometimes the urinary bladder. A urethroscope is a tiny camera installed at the end of a bendable probe. This allows the doctor to visualize the interiors of the constricted urethra. This procedure is carried out in the hospital.

• Retrograde Urethrogram - It is a test that helps determine the location, severity, and length of the stenosis (urethral stricture) using X-rays with a contrast dye agent. The contrast dye is inserted at the tip of the penis, and no catheters are used. The contrast dye helps the doctor visualize the interiors of the urethra.

How to Prevent Posterior Urethral Stenosis?

There are several ways to prevent the occurrence of the disease.

• Prevention from sexually transmitted diseases.

• Avoid urinary tract infections.

• Avoid trauma to the urethra (especially pelvic fractures).

• Wear a seat belt to avoid accidents.

• Follow-up is a must after prostate gland surgery.

• Use a lubricating jelly during self-catheterization.

• Use condoms during sex.

• Avoid sexual contact with infected partners.

• Visit the doctor immediately in case of any pain or trauma.

What Is the Treatment of Posterior Urethral Stenosis?

The treatment depends on eliminating the cause of the disease. No medications are required to resolve the condition. The therapeutic modalities include:

Stenosis Dilation - The stenosis is enlarged with the stretching of the urethral muscles gradually.

Urethrotomy - It is an operation that involves an incision in the urethra by a laser through a camera to provide relief in stenosis.

Open Surgery (Urethroplasty) - Surgically removing the scar tissue and eliminating the stenosis with surgical grafts. This procedure is called surgical graft reconstruction. There are two types of open surgery.

• Anastomotic Urethroplasty: This surgical technique is usually carried out for short urethral strictures. In this case, an incision is made between the scrotum and rectum. The reconnection of the urethra is established after the removal of the stricture. This is usually performed in a hospital. A soft, tiny catheter that is left inside the penis for approximately 15 to 21 days. The catheter is then removed. An X-ray is taken by the surgeon to ensure the healing process is taking place correctly.

• Substitution Urethroplasty: This technique is preferred if the urethral stenosis is long and too narrow. Surgical tissue graft reconstruction is required if the stricture is sufficiently long. This is done to replace the urethral section that has stenosis. Such reconstruction repair should usually be carried out by a specialist doctor (urologist). However, the prognosis is good for such surgery.

The three kinds of graft procedures are:

• Free graft (when the patient’s own tissue from either the skin or buccal mucosa is utilized to replace the section).

• Skin flap (skin flaps are rotated from the penile region to create a new urethral section).

• Staged (this method is employed when the local tissue does not work for the patient).

What Are the Complications of Posterior Urethral Stenosis?

If left untreated, the condition may progress to severe problems like urinary tract infections or infections in the testis. Even kidney stones might develop. Increased retention of urine may cause kidney problems in the long run.

What Precautions are Required After Treatment of Posterior Urethral Stenosis?

Urethral stenosis can recur post-treatment. Once the surgery is done, the doctor should do X-rays to check the status of the surgical treatment. Physical examination is also required to check the condition of the patient. Therefore, regular follow-up appointments with the healthcare professional are needed. This will ensure that the process of healing is taking place correctly and prevent the recurrence of the disease. If the stricture reoccurs, the surgical procedure might be repeated.

Conclusion:

To conclude, it is important to take urinary problems seriously. If the patient is experiencing pain while urinating or cannot pee, must immediately visit a doctor to confirm the diagnosis. Posterior urethral stenosis condition occurs when the uppermost part of the urethra constricts, preventing the flow of urine outside the body. However, the condition is curable, and the surgical procedure has a good prognosis. Regular follow-ups should be done to prevent recurrences.