Urethral stricture. Unpleasant pathology of the urinary system

Urethral stricture (stenosis) – pathology urethra, narrowing leading to obstructed fluid outflow. Characterized by pain, a feeling of incomplete emptying, frequent urges to the toilet. In most cases, it is diagnosed among men, but sometimes women and children are susceptible to the pathology.

General information

According to statistics, 1–2% of representatives suffer from urethral stricture strong half of humanity and no more than 0.5% of women. This is explained by the structural features urinary system. Even the symptoms of patients of different sexes can vary significantly.

Urethral stricture is considered serious urological problems requiring immediate treatment. If you do not consult a doctor promptly, you may severe consequences, including blockage of urine outflow and kidney failure.

ICD 10 code No. 35.

Anatomical aspects

The prevalence of urethral stricture in men is explained by the extent of the organ, which consists of several sections surrounded by the prostate membrane. Therefore, any infectious or inflammatory process, accompanied by an increase in the size of the prostate gland or injury to the penis, easily leads to compression of the passage and disruption of the outflow of fluid.

In women, the urethra is much shorter, so stricture is rarely detected.

Varieties

Urethral stricture is differentiated depending on etiology, location, and characteristics.

Etiological classification:

1. Post-traumatic – the provocateur is damage to the walls of the urethra.
2. Congenital - caused genetic disorders during the period of intrauterine development of the baby, it rarely appears.
3. Inflammatory - narrowing occurs due to an infectious-inflammatory process or replacement of connective organ tissue.
4. Idiopathic - diagnosed if the cause of the pathology is not clear.
5. Iatrogenic - occurs due to improperly performed medical procedures, sometimes becomes the result medical error.

Pathomorphological changes:

1. Primary – not accompanied by complications, first identified in the patient.
2. Recurrent - a repeated form, often occurring with the formation of fistulas and abscesses.

By location:

• prostatic;
• membranous;
• bulbous;
• capitate;
• stricture of the external part.

According to the size of the narrowed area of ​​the urethra:

1. Short – up to 2 cm.
2. Long – from 2 cm.
3. Subtotal - 2/3 of the organ is affected.
4. Total (panurethral) – along the entire length of the excretory canal.
5. Obliteration of the urethra - the passage is completely blocked.

Pathology is also classified depending on the severity of the process.

Stages of development

There are 3 characteristic stages of urethral stricture:

1. Initial – accompanied by damage to the epithelial layer.
2. Medium – diagnosed in the presence of urine leaks that provoke secondary infection.
3. The latter – scar tissue forms and grows, which leads to a sclerotic process.

Important! If you resort to therapy when a stricture is detected on early stage development, you can avoid complications, the treatment of which will take longer.

Features in men

The frequency of pathology among men is explained by the length and structure of the organ:

1. Prostatic section – the prostate gland is located around it. With her diseases, the canal is easily compressed.
2. Membranous – surrounded by the diaphragm.
3. Penile – extends to the external opening.

It is worth noting that along its length the male urethra consists of different tissues. Therefore, depending on the location of the damage, the signs of pathology can vary significantly. The most common option is narrowing of the prostatic segment.

The urinary tract in women is short and less susceptible to injury. However, the pathology often develops in young women, who are at risk for the growth of scar tissue and narrowing of the passage due to gynecological operations.

The defect develops in any segment of the urethra, and a large area is affected. The danger is that fluid retention causes overflow Bladder, which provokes compression and displacement of other organs, disruption of their functionality.

Pathology in a child

In children, urethral stenosis is usually caused by an abnormal intrauterine development urethra. As a rule, in boys, the area in the scrotum or in the lower part of the head of the penis will be narrowed. Except congenital causes, provoke stricture of injury.

In girls, excessive mobility of the urethra, as well as the elasticity of its tissues, becomes a factor in the pathology. But the problem is rarely diagnosed.

When should you be wary?

The clinical picture of the disease largely depends on the intensity of the process and the location of the stricture. Therefore, you should consult a doctor at the slightest change in urination - this will allow you to identify the pathology at an early stage.

Signals for medical help are:

1. Unpleasant sensations during bowel movements.
2. Feeling of constant fullness of the bladder.
3. Presence of blood in the urine.
4. Leakage of a small amount of liquid after visiting the toilet.

Important! One of characteristic features A stricture is a tight abdomen that is caused by problems with urine output.

Main reasons

Among the factors leading to the development of the defect, congenital make up only 2%, iatrogenic 13%, inflammatory 15%, post-traumatic 70%.

It is possible to trace which provocateurs most often lead to pathology.

How independent problem, stricture is rarely diagnosed.

The main signs of pathology include:

1. Delayed urination or complete absence.
2. Weak liquid flow, splashing.
3. The need to strain the abdomen during the process of emptying.
4. Feeling of bladder fullness after going to the toilet.
5. Liquid leakage.
6. Pain in the pelvic area.
7. The presence of blood in urine or semen.

The clinical picture often develops rapidly, the symptoms appear clearly. During sexual intercourse, the secretion of seminal fluid decreases.

Possible complications

If urethral stricture is not treated, severe consequences develop over time:

1. Atrophy of the bladder as a result of overstrain of muscle tissue.
2. Infectious and inflammatory processes due to constant stagnation of urine, which easily become chronic. These include cystitis, orchitis, pyelonephritis.
3. Renal dysfunction, renal failure.
4. The formation of stones is urolithiasis.
5. Hydronephrosis of the kidneys, characterized by dilation of the pelvis of paired organs.

Even after surgical treatment the following complications are possible:

1. Recurrence of stricture.
2. Bleeding.
3. Blood saturation of the spongy tissue of the penis, which promotes fibrosis.
4. Displacement of the stent installed in the lumen of the canal, which causes pain in a sitting position and during sexual contact, injures the mucous membrane of the organ.

To avoid complications, it is necessary to resort to examination at the first signs of a defect.

Diagnostics

To draw up a quality therapy program, it is necessary to identify the cause of the narrowing of the urethra. To do this, the patient is prescribed the following procedures:

1. A swab is taken from the urethra to bacteriological culture, direct immunofluorescence, PCR - help identify infection or antigens, pathogen DNA.
2. General urine test for the level of leukocytes, red blood cells, protein, and the presence of pus.
3. Uroflowmetry - to determine the speed of urine movement.
4. Ultrasound of the bladder and pelvic area, kidneys - makes it possible to visually assess the volume of residual urine and identify lesions of other organs.
5. Urethrography or radiography - if stones are suspected.
6. Rectal palpation - to study the size and texture of the prostate gland.
7. Multislice computer voiding cystourethrography - CT for layer-by-layer examination of tissues during the process of emptying.
8. Cystoscopy is an examination of the bladder with a cystoscope with a built-in camera.

The treatment regimen is based on the results obtained. It is advisable to give it to a urologist detailed description clinical picture so that a medical error does not occur due to the similarity of symptoms with signs of other problems genitourinary system.

Important! Depending on the cause, the diagnostic program can be expanded.

Pathology therapy

In the vast majority of cases, the defect is treated surgically. Conservative methods indicated if the stricture is infectious in nature - as additional measure antibacterial and anti-inflammatory drugs are prescribed, with the help of which they destroy pathogens and reduce severe symptoms.

Stricture surgery

Which operation is indicated for the patient depends on the severity of the pathology, the size of the stricture, the number of narrowings, and the presence of complications. There are several common methods that allow you to remove the defect, restore the natural flow of urine, and eliminate the clinic characteristic of the disease.

Bougienage

This operation involves widening and stretching the canal by installing a special metal rod or balloon catheter. The indication is the presence of a lesion no more than 2 cm long or a single stricture with a uniform narrowing of 5–6 cm in length.

Flaws:

1. The risk of complications caused by organ injury general condition patient. Sometimes the urethra has to be not just stretched, but torn.
2. Frequent relapses. At the same time, there is an increase in the size of the scars.
3. It does not allow you to restore blood circulation, violations of which often become the cause of the defect.

Important! Repeated use of the procedure is not recommended.

Optical urethrotomy and laser treatment

Internal optical urethrotomy is performed for stricture small size. Using a urethral cystoscope, the affected section of the organ is dissected and a metal rod is inserted. However, the technique does not completely heal the patient, since after an operation of this type, after 2–3 months, the urinary canal is again subject to narrowing. The exception is if the process proceeds with minimal fibrosis and it is possible to completely excise the connective tissue.

Optical urethrotomy is not repeated.

Laser surgery is considered the least traumatic. Sclerotic areas of the mucosa are burned out with a laser. After the procedure, anti-burn solutions and ointments are used to treat wounds. But even with this technique, relapses are observed in 40–50%. Largely a risk re-development pathology depends on the correct selection during recovery medicines.

Stenting

A special spring or stent is inserted into the lumen of the urethra, which allows you to expand the canal in a narrowed area. The operation is rarely practiced, as there is a high probability side effects, for example, displacement of the stent, which leads to injury to the wall. As a rule, the technique is indicated if the stricture is less than 0.5 cm.

Excision of part of the urethra

A urethroscope is used to resect the urethra or a limited area thereof. After excision of the damaged segment, the ends of the urethra are sutured. If it is necessary to remove a large part of the passage, complex surgery is performed, including excision of tissue, as well as its replacement with a graft made from the mucous membrane of the patient’s lips or cheeks, foreskin. When it is necessary to completely remove the urethra, a special catheter is inserted, through which urine is removed.

This technique is preferable when we're talking about both small and extended defects located in various parts of the urethra. The method allows you to completely cure the patient if the length of the stricture is no more than 1 cm. A positive result is achieved in 80%.

As a rule, damaged tissue is removed with a laser, and a graft is sewn in its place. Relapses occur in only 10%.

Traditional methods of treatment

Therapy at home involves the use of decoctions from medicinal herbs. They are most often prepared from the following plants:

• black poplar;
• juniper;
• elderberries;
• chamomile;
• currants;
• bearberry;
• yarrow;
• St. John's wort.

Such means enhance diuretic effect, have anti-inflammatory properties, therefore the use is indicated folk recipes in the recovery period.

1. Currant leaves are poured with boiling water and left in a closed container for several hours.
2. Mix birch leaves, bearberry and licorice. Pour 12 g of the collection with water and keep in a steam bath for 15 minutes. Then the broth is infused in a thermos.

Important! Not every stricture can be treated traditional methods. Often the use of herbs provokes an increase in the defect. Before resorting to home therapy, consult a urologist. In addition, it is necessary to take into account contraindications to medicinal compositions, For example, allergic reaction to components.

Another way is to use leeches, which are placed directly on the ureter area. A hirudotherapy session lasts up to 8 hours. The procedure must be performed by a specialist and only with the permission of a doctor.

Rehabilitation after illness

Since stricture therapy is performed surgically, you need to carefully monitor the condition of the wound and avoid urine leakage into the area of ​​the postoperative suture. Therefore, patients are fitted with a catheter, which facilitates the removal of fluid.

However, this method also provokes complications, for example, cystitis. To prevent the development of an inflammatory process, you need to change the tube at least once every 7 days, treat the bladder antiseptic solutions, which are infused directly through the catheter.

Also for quick recovery Physiotherapy is indicated - galvanization, diathermy, magnetic therapy. The procedures promote healing and increase the flow of oxygen to tissues by normalizing blood circulation.

Features of nutrition and lifestyle

Urethral strictures and surgery act as provocateurs for the formation of sand and stones. Therefore, patients should adhere to dietary table No. 7 in preparation for surgery and during the recovery period.

1. Minimize the number of dishes and foods that can increase the volume of daily urine.
2. Avoid alcoholic drinks.
3. Completely avoid seasonings, marinades, hot spices, fatty and fried foods that increase thirst.

Physical activity is limited at first, but as rehabilitation progresses, sports activities are encouraged.

Prognosis and prevention

There are several rules that you can follow to reduce the risk of pathology.

1. To avoid treatment of urethral stricture in men and women, you should use protection during sexual contact, avoid random connections. Sexually transmitted diseases are one of the reasons for the development of the defect.
2. Use personal towels for genital hygiene.
3. It is advisable to perform medical procedures involving catheterization with caution.
4. Avoid risk of injury bottom part belly.
5. Undergo preventive examinations.
6. Treat diseases of the genitourinary system in a timely manner.
7. In the autumn-winter period of the year, avoid hypothermia.

The prognosis for early detection of the problem is favorable. Therefore, at the first warning signs you need to visit a doctor. The more you start the process, the less chance of complete healing.

Urethral stricture is urological disease, which is characterized by a narrowing of the lumen in the urethra due to a scar-sclerotic process. The causes of the disease are different, but the result is always the same - disruption of the normal outflow of urine from the bladder cavity. This diagnosis causes men psychological and physical discomfort.

If the patient ignores the problem, the disease will lead to a number of serious complications (spongiofibrosis, renal failure, hydronephrosis, various bleedings). Urethral stenosis in children poses a great danger because pathological disorders occur in an organism that is not yet fully formed.

Strictures have different etiologies. According to the nature of their course, they are divided into primary, recurrent, or diseases that occur with complications. Medical practice shows that the obstruction is localized either in the anterior part of the urethra or in the posterior part, located near the bladder.

Why is it so important to diagnose and eliminate strictures in the urethra in a timely manner? The fact is that obstructed urine outflow provokes the proliferation of infectious bacteria. He suffers greatly from this important organ– kidneys. And such consequences may well threaten the patient’s life.

Urethral strictures can be congenital or acquired during a person’s life. In the first case, the disease is caused exclusively congenital anomalies development genitourinary organs(narrowed urethral stents are formed in boys in the womb).

Acquired obstruction of the urethra in men occurs in the following cases:

• Injuries received throughout life (so-called post-traumatic urethritis). These include mechanical damage in case of a fall, shock, thermal or chemical burn tissues, wounds of a penetrating nature into the genital area. Post-traumatic urethral stricture occurs after fractures of the pelvic bones (industrial accidents, falls from great heights). Often, damage to the urethra occurs during sexual intercourse (ruptures of the external tissues of the genital organ with bleeding). Damage and scarring develops after large stones pass through the canal during urolithiasis (urolithiasis).
• Unqualified or incorrectly performed urological manipulations and surgical interventions.
• Acute or chronic inflammation in tissues urethral canal ().
• Strictures as a result of radiation therapy. The disease becomes a complication after treatment of cancerous tumors or benign tumors of the genitourinary system.
• Obstruction, which is secondary disease for ailments that are characterized by disruption of the normal blood supply to tissues in the pelvic area. These include arterial hypertension, ischemia of the heart muscle, diabetes mellitus, and abnormalities in the functioning of the pancreas.

Most often, when compiling a clinical picture of a disease, it is its acquired causes that are noted. Congenital pathologies occur in only 2% of patients.

Symptoms of the disease

Narrowing of the urethral meatus is a pathology that is accompanied by pronounced, painful symptoms. It most often manifests itself as follows:

1. Difficulty passing urine through the canal. Discomfort is felt at the beginning and throughout the act of urination.
2. Pain of varying strength while emptying the bladder. The sensations extend not only to the genitals, but also to the abdominal area.
3. Lack of feeling of natural, complete emptying of the bladder. Moreover, the patient can feel the presence of fluid in the organ even after next visit toilet.
4. Uncontrolled release small quantity urine, leakage during coughing, sneezing.
5. With severe stenosis of the urethral canal, the amount of urine is noticeably reduced. In particularly advanced cases, it can be released drop by drop, until the natural outflow is completely blocked (urethral obliteration).
6. Bloody discharge from the genital organ, which is observed regardless of the process of urination.
7. . In this case, the patient may be bothered by partial sexual dysfunction.
8. The stream of urine becomes bifurcated, and urine splashes.

The disease is often accompanied by general malaise, weakness, loss of appetite and physical activity patients.

Diagnosis of urethral strictures

Detection of the presence of the disease in a man should begin with a visit to a specialist. He will ask the patient to voice complaints and list the symptoms that have appeared. Next, the following types of studies will be assigned:

• . Allows you to identify the internal inflammatory process by assessing the level of leukocytes, protein and red blood cells blood cells(erythrocytes). The study also makes it possible to detect pus and mucus in urine.
• Urine culture to identify bacteria and microorganisms. This study simultaneously determines sensitivity to various kinds antibiotics.
• . The doctor performs the manipulation immediately after urination. The amount of residual urine and the degree of deterioration in organ functionality are determined.
• Measurement of specific urine flow rate (or uroflowmetry). To carry it out, a special uroflowmeter device is used.
• X-ray contrast diagnostics. Allows you to determine the length of the urethra affected by the stricture, its location, the presence of injured areas, and stones. The contrast agent is applied to the area under study in two ways: intravenously or directly through the opening in the penis (retrograde urethrography). The intravenous method makes it possible to assess and photograph the condition of the bladder tissue, the extent of the narrowing, and analyze the functioning of the excretory organs.
• Diagnosis by endoscopy. Inserting an endoscope into the affected organ will allow you to examine it from the inside, reach narrowed areas and collect tissue for biopsy.
• Ultrasound of the kidneys. This additional research, which the doctor prescribes to obtain a complete picture of the condition of the urinary organs.

Treatment of urethral stricture

Treatment of urinary obstruction in men today is carried out in several ways. Each of them can be chosen by the attending physician after a thorough examination of the problem. The determining factors are the length of the scar areas, their localization and the degree of modification.

If the stricture has affected the bulbar urethra and the length of the fibrous area does not exceed 1.5 cm, then an internal optical urethrotomy (or IOU) is performed. This operation involves longitudinal dissection of the urethra at the site of narrowing. In order for the manipulation to be effective, a complete incision of the spongiofibrosis to the corpus spongiosum is necessary. VOU is indicated for those patients in whom urethral stricture has caused minimal spongiofibrosis. If, upon re-diagnosis, a decrease in the modified area is noted, then it is advisable to repeat the optical urethrotomy.

Bougienage of the canal (expansion or dilatation). During surgery, the patient is given special dilators made of plastic or metal to increase the lumen in the urethra. Often, instead of rods, balloon-type catheters and a urethral clamp are used. The balloon-shaped tip is gradually inflated, stretching the scar area.

To avoid relapse and re-formation of narrowing, they resort to the introduction of a urethral stent. This device regulates the sufficient distance between the walls of the urethral canal so that urine can flow through them.

If the pathology has caused complete retention of urine in the bladder, then it is advisable to perform a cystostomy of the organ. A small puncture is made in the bladder through which the surgeon passes a catheter tube. After surgery, urine will be drained through this device.
Laser treatment is considered last resort, which involves excision and removal of the pathological area of ​​tissue, suturing the formed ends of the urethra. If the stricture has a maximum extent, then after laser surgery the so-called “restoration” of the urethra occurs. For the purpose of replacement, other healthy tissues of the patient are used.

Disease prevention

Preventing the development of fibrotic processes in the urethra is an important measure that every man should remember. Prevention, first of all, lies in caring for own health. If you have developed any disease in the genitourinary system (inflammatory or infectious), then under no circumstances should you refuse to visit a doctor and qualified treatment. Avoid any injuries that could cause irreparable harm to men's health.

Urethral stricture – pathological disease, in which the urethra narrows. This occurs because the normal mucous membrane and the surrounding spongy tissue of the corpus spongiosum of the urethra are replaced by scar tissue.

This pathology ranks second among the reasons that disrupt urinary emptying. The first place here is given to adenoma and hyperplasia. There are several forms of this disease, they are graded according to severity (from slight difficulty in urination to its absolute impossibility). In addition, urethral stricture can be congenital (this type of disease is extremely rare) or acquired.

The structure of the male urethra

The symptoms that appear with urethral stricture may indicate the presence of other serious pathologies and diseases. Especially if it appears after 40 years. A stricture manifests itself as follows:

1. weak urine stream
2. decreased amount of urine when urinating
3. feeling that the bladder is full even after urinating
4. waiting a long time before urination begins
5. abdominal tension to urinate
6. pain, discomfort while going to the toilet
7. bleeding
8. abdominal pain

Often, after contacting a specialist with the above complaints, patients are given misdiagnosis due to insufficient examination. To rule this out, contact only those doctors who specialize in the treatment of urethral stricture.

Causes

Most often, the cause lies in damage to the urethra itself. They can be traumatic, chemical, radiation, infectious-inflammatory and thermal. In this regard, the following main causes of stricture can be identified:

• injury to organs located in the pelvis
• diseases of infectious origin
• malignant formations
• errors when instrumental study, after which wounds form and scar
• irradiation
• skin inflammation

Urethral stricture

Treatment

The main methods of treating urethral stricture are:

1. Bougienage
2. Optical urethrotomy
3. Stenting
4. Surgical reconstruction
5. Laser treatment

The first two methods appeared a long time ago, and have been effectively used in the treatment of strictures for many years.

When bougienage occurs, stretching, spreading, and sometimes tearing a narrow section of the channel through which urination occurs. This is done with a metal rod that has a smooth surface and different diameters. However, despite all the advantages this method, it is not capable of giving complete cure. The urethra enlarges only for a while, but the main causes of stricture - impaired blood supply to the narrowed zone - are not eliminated. Very often, after bougienage, the disease recurs; moreover, the stricture becomes rougher and more prolonged. The more often bougienage is done, the more it harms the patient’s health.

Urethrotomy is also not able to completely eliminate the disease. And this despite the fact that in last years the procedure is performed using a cystoscope. During the procedure, the doctor dissects the narrowed section of the urethra. Otherwise, urethrotomy is similar to bougienage and differs from it only in that the relapse rate is slightly lower.

In view of the above, urethrotomy and bougienage are prescribed to the patient only if the urethral stricture is not too large (up to half a centimeter). In other cases, these methods act only as treatment aids.

If the patient’s disease recurs after urethrotomy or bougienage, it is strictly contraindicated to use these methods again.

A urethral stent (or a special spring) holds narrow part dilated urethra. The only “disadvantage” of this method is that the stent can migrate and become dislodged, and this can lead to serious complications. This is why stenting is rarely used.

One of modern methods treatment of urethral stricture is Plastic surgery. It is used if the lesion is more than 1 cm. The operation of urethral stricture consists of replacing the urethra, which is affected by the stricture with healthy tissue. The effectiveness of this operation is more than 80%. Plastic surgery helps to cure even those patients in whom almost the entire urethra is affected by stricture

Treatment of urethral stricture with laser is a short-term surgical intervention, which is considered the most favorable method. Before the operation, the patient must undergo an optical examination of the urethra.

Chronic urethral stricture

If the disease has taken chronic course, treatment always involves surgery. The fact is that untreated stricture can lead to serious complications in the future. The process of urination gradually becomes more difficult, and opening the neck of the bladder becomes difficult. All this can lead to anuria, as a result of which the urologist may decide on catheterization or other drastic measures.

Diagnostics

When a patient contacts a urologist with severe symptoms, the doctor must first find out the true causes of urethral stricture.

Bougienage of the urethra

If an inflammatory stricture is suspected, it is necessary to carry out laboratory research: a smear is taken to check for sexually transmitted infections, PCR diagnostics and bacterial culture are performed.

It is impossible to make a diagnosis without uroflowmetry, cystometry, profilometry, and video-urodynamic examination.

Ultrasound of the bladder helps determine the volume of residual urine. It is recommended to do it immediately after bowel movement. This research method helps to judge the degrees of functional decompensation.

Endoscopic diagnostic methods make it possible to examine and thoroughly study areas of strictures, find out the causes of the disease, and conduct a biopsy for morphological research.

Treatment with folk remedies

It is also possible to treat urethral stricture folk remedies. IN folk medicine For these purposes, a variety of herbal infusions and decoctions are used. For example, black currant. For a day you will need a decoction of 3 tablespoons of blackcurrant leaves poured with a glass of boiling water. At acute inflammations Decoctions of currant berries help a lot – they are used as diuretics and anti-inflammatory agents.

In some cases, they cope well with urethral strictures leeches. They are applied along the skin lines with a projection onto the ureter. Sessions last 6-8 hours. The interval between sessions is about three days. This treatment relieves inflammation, restores and stimulates the functioning of the ureters.

Principle of urethroplasty

An excellent anti-inflammatory agent with diuretic and antimicrobial effect have juniper, black poplar, chamomile, lingonberry, black elderberry.

An excellent remedy for strictures - herbal tea, a decoction of which should be taken every hour an hour before meals, half a glass. Prepare for this. Mix birch leaves, flaxseed, licorice root, bearberry leaves. It's equal in total. To prepare the decoction you will need 10 g of this collection. When you measure it, add 300 ml of boiling water and simmer in a water bath for about 10 minutes. Then pour the finished broth into a thermos and leave to steep for a couple of hours.

Another collection is also no less useful, but it is prepared a little differently. The mixed ingredients (equal parts: juniper, parsley root, hernia, yarrow) should be crushed to a powder. Then measure out 10 g of powder and pour a glass of boiling water, boil for another five minutes and leave for a couple of hours. After this, the broth should be filtered and taken half a glass 4 times after meals.

Decoction lingonberry leaves, flaxseeds, calendula flowers, violets, lovage, take half a glass three times a day before meals. First mix the ingredients in equal parts, measure out 10 g of the collection, then pour 300 ml of boiling water and simmer in a water bath for 10 minutes. Leave in a thermos for two hours, then strain and take as described above.

Has an excellent effect decoction from the following herbs: cornflower flowers, wintergreen leaves, angelica root, cinquefoil and nettle herbs are mixed in equal quantities and are crushed. You will only need 8 g of this powder. Fill it with a glass of boiling water and leave it in a thermos for at least 4 hours. Then we filter and drink half a glass three times a day, half an hour before meals.

Preventive measures

First of all, prevention of urethral stricture is aimed at eliminating unfavorable factors that provoke narrowing or damage to the urinary canal.

In order to protect yourself from stricture, be sure to use condoms during sexual intercourse!

Gonococci and chlamydia are infections that can primarily provoke the development of the disease. You can become infected with them during casual sex.

Do not allow medications or other agents that may cause burns to the mucous membranes to enter the urethra. Any inflammation of the urethra should be treated immediately. At the first sign of infection or inflammation, be sure to seek medical attention. medical assistance.

2

Make an appointment with a doctor right now and don’t put off the problem for later.

The male urethra (urethra masculina) is about 18 cm long; its larger part predominantly passes through the corpus spongiosum of the penis (Fig. 329). The canal begins in the bladder with the internal opening and ends with the external opening on the head of the penis. The urethra is divided into prostatic (pars prostatica), membranous (pars membranacea) and spongy (pars spongiosa) parts.

329. Longitudinal section of the urethra and bladder (according to Kiss, Szentagotai).

1 - vertex vesicae;
2 - tunica muscularis;
3 - tunica mucosa;
4 - tela submucosa;
5 - plica interureterica;
6 - ostium ureteris;
7 - trigonum vesicae;
8 - prostate;
9 - colliculus seminalis;
10 - pars membranacea urethrae;
11 - bulbus urethrae;
12 - pars cavernosa urethrae;
13 - ostium urethrae;
14 - corpus spongiosum glandis;
15 - fossa navicularis;
16 - corpus cavernosum penis;
17 - chapter. bulbourethralis.

The prostate part corresponds to the length of the prostate gland and is lined with transitional epithelium. In this part, a narrowed place is distinguished according to the position of the internal sphincter of the urethra and, below, an expanded part 12 mm long. On back wall The expanded part houses the seminal tubercle (folliculus seminalis), from which the comb (crista urethralis), formed by the mucous membrane, extends up and down. There is a sphincter around the mouths of the ejaculatory ducts, which open on the seminal tubercle. In the tissue of the ejaculatory ducts there is a venous plexus, which acts as an elastic sphincter.

The membranous part represents the shortest and narrowest section of the urethra; it is well fixed in the urogenital diaphragm of the pelvis and has a length of 18-20 mm. Striated muscle fibers An external sphincter (sphincter urethralis externus) is formed around the canal, subordinate to the human consciousness. The sphincter, except for the act of urination, is constantly contracted.

The spongy part is 12-14 cm long and corresponds to the corpus spongiosum of the penis. It begins with a bulbous extension (bulbus urethrae), where the ducts of two bulbous urethrae glands open, secreting protein mucus to moisturize the mucous membrane and liquefy sperm. Bulbo-urethral glands, the size of a pea, are located in the thickness of m. transversus perinei profundus. The urethra of this part starts from the bulbous extension, has a uniform diameter of 7 - 9 mm and only in the head it turns into a fusiform extension called the scaphoid fossa (fossa navicularis), which ends with a narrowed external opening (orificium urethrae externum). In the mucous membrane of all parts of the canal there are numerous glands of two types: intraepithelial and alveolar-tubular. Intraepithelial glands are similar in structure to goblet mucous cells, and alveolar-tubular glands are flask-shaped and lined with columnar epithelium. These glands secrete a secretion to moisturize the mucous membrane. The nasal membrane of the mucous membrane is fused with the spongy layer only in the spongy part of the urethra, and in the remaining parts with the smooth muscle layer.

When considering the profile of the urethra, two curvatures, three expansions and three narrowings are distinguished. The anterior curvature is located in the root area and is easily corrected by elevating the penis. The second curvature is fixed in the perineal area and goes around the pubic fusion. Canal extensions: in the pars prostatica - 11 mm, in the bulbus urethrae - 17 mm, in the fossa navicularis - 10 mm. Narrowing of the canal: in the area of ​​the internal and external sphincters, the canal is completely closed; in the area of ​​the external opening, the diameter decreases to 6-7 mm. Due to the stretchability of the canal tissue, if necessary, it is possible to insert a catheter with a diameter of up to 10 mm.

– treatment can be quite complex and unpleasant. This disease is very rare, but the frequency of its occurrence in men is higher than in women, since the structure of the urethra in the female and male urinary systems is different. When a man consults a doctor with signs of a stricture (impaired urination, incomplete emptying, foreign discharge), doctors do not always immediately correctly determine the diagnosis: its symptoms are very similar to problems with the prostate gland. This negatively affects the prognosis of the disease - the wrong therapy is prescribed, and in the meantime the pathology worsens.

Why is it necessary to treat

When it appears, narrowing and stenosis of the urethra occurs in its various parts. At the site of pathology development, the delicate tissue that lines the inside of the urethra is transformed into a hard, rough, scarred membrane. This disease is expressed in different forms.

Thus, this disease can significantly complicate the functioning of any part of the urethra, up to the complete impossibility of urination. Retention of urine in the body leads to serious disorders internal environment body and its intoxication. Even partial, temporary stagnation of urine in the lumen of the urethra can lead to severe inflammation, including infectious processes, weakening of the pelvic muscles, accumulation of sand and stones. Such symptoms can significantly affect not only physiological state And sexual function, but also pose a threat to the patient’s life in severe cases, especially when pathological changes affect the kidneys. Therefore, in case of stricture, it should be considered not just necessary, but vital.

How to treat the disease

The very first step in treating a disease is correct diagnosis, for which you must contact qualified specialists. You should go to a medical facility immediately after early signs appear (urinary retention, difficulty emptying the bladder, splashing of the stream or its complete absence, when urine flows out in drops or does not pass at all).

The choice of treatment tactics depends on what form of the disease develops. To clarify the characteristics of the stricture, various examinations are necessary: general analysis urine and her bacterial culture, smear, ultrasound of the affected area of ​​the urinary system, X-ray studies. The degree of disturbance of urine outflow can be assessed using uroflowmetry, cystometry, and profilometry. Urethroscopy together with biopsy can be used not only as diagnostic method, but also for therapeutic surgical purposes. Only comprehensive diagnostics gives a complete picture of the disease and determines the direction further actions attending physician.

In the treatment of strictures can be used different methods direct impact on the affected area of ​​the organ (bougienage, laser, endoscopic and other techniques) and additional drug treatment. Medicines you may need:

• antifungal, antiviral drugs and antibiotics;
• agents that help relieve inflammation and heal wounds;
• The operations are accompanied by local or epidural anesthesia. General anesthesia is rarely used.

Traditional methods can alleviate the symptoms of the disease, but they cannot be used as the main or sole therapy, since none of the known recipes can eliminate the pathology quickly and efficiently, and delay in effective treatment with such an illness it can cost the patient his life. But in the absence of contraindications and with the approval of the attending physician, you can use herbal remedies or homemade herbal decoctions (chamomile, lingonberry, poplar, black elderberry, yarrow). Some specialists practice hirudotherapy in the fight against urethral stenosis.

Bougienage and optical urethrotomy

This method of eliminating stenosis cannot be called very effective, since it does not guarantee the absence of relapses and complications, and the procedure cannot be repeated, because the tissue may no longer recover. Its essence is to stretch the lumen with a metal rod at the point of its narrowing. In some cases, the doctor even tears the wall of the urethra. This technique is used only for short or medium-sized single strictures. Such an intervention can only be entrusted to experienced, qualified physicians, since mistakes and careless movements can lead to additional injuries to the organ.

Optical urethrotomy is similar to bougienage, but excision of the urethra is performed using a cystoscope. It is used in the same cases as the previous method, and also once, without the possibility of repetition in case of relapse. Urethrotomy cannot be performed for infectious diseases not only of the urinary system, but also of other organs.

When stenting, a special spring is placed into the narrowed lumen, which stretches it. The disadvantage of the procedure is that such a urethral stent can move and cause complications. But this technique can be used in patients for whom surgical interventions are contraindicated and there is a need urgent help in draining accumulated fluid. Sometimes stenting is used as a preparatory step before the main operation.

The coils or springs can be permanent or absorbable. Permanent implants are installed for life, but later they can cause recurrence of the disease. Stenting is not recommended for recurrent urinary tract infections, urinary incontinence, or bladder stones.

Laser therapy and endoscopy

Laser therapy is considered low-traumatic for the patient. After optical examination of the urethral canal, a short, minimally invasive surgical intervention is performed. Under the influence of a laser, the affected tissue is burned out, and the remaining burn is healed using medications. However, incorrect, ineffective drug therapy can lead to relapse, when a new scar grows at the burn site.

Small stenoses in different areas the urethra can be eliminated using internal urethrotomy. Endoscopy is performed without equipment, and after the intervention a catheter is installed (for 1–2 weeks). This makes it possible to remove accumulated fluid from the body and temporarily alleviate the patient’s condition.

It involves a surgical intervention in which diseased tissues of the organ lining are replaced with healthy ones. Moreover, in severe cases, it is necessary to take transplants from distant organs of the patient, for example, from the inner surface of the cheek.

This method makes it possible to eliminate stenosis with multiple foci of narrowing of the lumen. It is considered the most effective, as it allows you to completely remove the affected tissue, after which recovery takes place normal function urethra. At correct execution After all manipulations, relapses of the disease are excluded.

Treatment of a stricture can be very unpleasant and time-consuming, but often without the use of surgical interventions different types not enough. It is very important to go through everything before surgery necessary examinations so that the doctor has full view about the pathology, its localization, severity. If there are infectious diseases of any organs, they need to be cured as quickly as possible, since intervention can provoke the spread of pathogens. Accurately identify this rare disease and choose optimal scheme treatment can only be performed by a qualified specialist.