What is Urethral Stricture?
The urethra is a tube that connects the urinary bladder to the urethral meatus. The urethral meatus is the opening of the penis that assists in the flow of urine outside the body. Because of various reasons such as infective urethritis, non-infective urethritis, instrumentation, prostate enlargement, and injury, this tube gets constricted. The symptoms experienced by the patient depends upon the severity of stricture. Some patients may not have any symptoms while others have symptoms of varying severity. Men are more affected by urethral strictures as compared to women. In fact, the urethral stricture is rare in women and girls. Pathophysiology of the disease indicates fibrosis of spongiosum as a reason for urethral strictures.
Causes of Urethral Stricture
In developed countries, most urethral strictures occur without any known cause while in developing countries, trauma is most common cause. In developed countries, people may also develop urethral strictures due to iatrogenic effect. Following are some of the causes of urethral strictures:
Trauma: Trauma is a common cause for urethral strictures. Trauma may be caused due to injury on the area near scrotum or falling on the perineum. Urethral stricture may also occur due to falling on bicycle bar.
Medical Procedure: Various medical procedures such as prostatectomy, prostate brachytherapy, hypospadias correction surgery, and catheterization may lead to urethral strictures.
Prostate disorders: Prostate gland disorders also cause urethral strictures. It includes prostate hyperplasia and prostate cancer.
Infections: Urethral strictures may also be caused due to infections such as sexually transmitted diseases.
Cancer treatment: Radiation therapy may also lead to urethral strictures.
Symptoms of Urethral Strictures
Symptoms vary with the severity of fibrosis in the urethra. Some patients may not notice any symptoms while severe symptoms are experienced by other patients. Some of the common symptoms of urethral strictures are:
Changes in urine determinants: The urine stream gets weakened and the volume is reduced. The patient is not able to control urination and also experience incomplete bladder emptying even after urination.
Changes in urine composition: The urine, in urethral stricture may contain blood. Further, the urine is comparatively darker in color.
Pain and inflammation: Patient may also experience pain and inflammation in the penile region and pelvic region.
Best Urethroplasty Surgery Hospitals in Delhi
If you are looking for Best Urethroplasty Surgery Hospitals in Delhi, India, the best choice is SCI International hospital. With its ultra-modern technologies, highly experienced and renowned urology surgeons and world-class pre and post-surgical care have made this hospital one of the best in urology care. SCI International Hospital is capable of conducting complex reconstructive Genito-urinary surgeries with high accuracy, precision, and ease. Genito-urinary surgeries performed in hospital for various diseases including urethral strictures, hypospadias repair, scrotal lymphedema, traumatic urological injuries, Peyronie’s Disease, Pelvic Fracture & Urologic Injury, and priapism. World-class services such as Circumcision & Frenulotomy, Inguinal & Testicular Surgery, Urinary Diversion, Genital Reconstruction, Urethral Surgery, Vasectomy, and bladder augmentation are available at SCI International hospital. Experienced urology doctors like Dr. Vishal Dutt Gaur and Dr. Gautam Banga are providing their services at SCI International Hospital.
How to do the Diagnosis of Urethral Strictures?
Various options are available for diagnosis of urethral strictures:
Physical evaluation: During a physical evaluation, the doctor will ask about the symptoms experienced and the medical history of the patient. Prostatectomy in the past may increase the risk of urethral strictures.
Urinary tests: Various tests related to urine and urine flow are performed to evaluate the reason for symptoms. Through the urinary flow test, the strength of urine stream and volume of urine is analyzed while tests on urine are done to find the presence of blood or infection.
Imaging techniques: While pelvic ultrasound and pelvic MRI is done to evaluate the incomplete emptying of the bladder or any pelvic injury, retrograde urethrogram is done to find any structural abnormality. For a comprehensive analysis of urethra and bladder, cystoscopy may also be done.
What is Urethroplasty Surgery?
Urethroplasty is a type of surgery done for reconstruction of urethra. Reconstruction is done to repair the problems associated with urethra such as urethral strictures. The main aim of this surgery is to increase the size of the urethra to promote proper urine flow. The complications of urethroplasty can be minimized with accurate and precise surgery as well as excellent post-operative care. As with other surgeries, urethroplasty may cause pain and discomfort, but it can easily be subsided with the help of proper treatment. Advantages of urethroplasty over other treatment options include improved quality of life and minimum chances of recurrence of urethral strictures.
What are Preparations for Urethroplasty Surgery?
Various instructions are to be followed by patients before surgery. The patients are advised not to drink or eat anything at least 8-10 hours before surgery. On the day of surgery, patients may take medications if not refrained by the surgeon. If urethral strictures are caused due to pelvic fracture, the patient is advised to get admitted in the hospital a day before surgery. Various tests are done at the hospital to ascertain that patient is fit for undergoing surgery. The patient should not have any type of infection especially urinary tract infection. Bowel cleaning procedure may also be required prior to this surgery. If the patients experience any change in health such as cough, fever or diarrhea, such information should be shared with the surgeon.
Types of Urethroplasty Surgery
Following are the types of urethroplasty surgery:
Anastomotic urethroplasty: Excision and primary anastomotic (EPA) urethroplasty is a preferred choice in the management of urethral strictures because of its high success rate. It does not damage the vascular integrity of spongiosum.
Buccal mucosal graft: Because of its unmatched advantages, buccal mucosal graft has registered itself in the reconstructive urology. One team is involved in buccal grafting while the other team performs the penile incision.
Scrotal or penile graft: The success rate of less than 90% make this procedure least preferred. However, the process is generally used in strictures greater than 4 cm in length.
Why consider India for Urethroplasty Surgery?
Urethroplasty is a complicated surgery and required to be done by expert urology surgeon. With its huge healthcare infrastructure, experienced urologists with advanced degrees and training and caring through modern facilities after surgery has made India a favorite destination for urethroplasty. Various options are available for patients as this surgery is done in various hospitals in India with world-class facilities. Cost or urethroplasty, which is an important factor in decision making, is also low in India as compared to other countries. Apart from known for its medical tourism, India is one of the most favorite tourist destinations.
Some of the treatment options available for urethral strictures include:
Catheterization: If the patient is diagnosed with very small urethral strictures, self-catheterization may be a possible option for treatment. A tube is inserted to the bladder and the urine is drained to provide relief from symptoms.
Urethral dilation: Commonly used in patients with recurrent strictures, this treatment involves dilation of urethral opening with the help of a wire.
Direct vision internal urethrotomy (DVIU): This treatment option is commonly used strictures present in bulbar urethra. The procedure is done with the help of a camera and a knife.
Urethral stent placement: In order to increase the diameter of the urethra, a stent is placed to improve urine flow.
Urethroplasty: Because of its long-term efficacy and high success rate, urethroplasty is considered a gold standard in the treatment of urethral strictures.
Best urethroplasty surgeon in Delhi NCR
Urethroplasty surgeons are rated on the basis of various factors. These factors include education, training (national and international), years of experience, hospitals with whom they are associated and surgery success rate. It is hard to identify best urethroplasty surgeon in Delhi-NCR, but Dr. Vishal Dutt Gaur and Dr. Gautam Banga are highly renowned urethroplasty surgeons in Delhi-NCR region. In 12 years of his professional life, Dr. Gautam Banga has successfully conducted over 1200 urethroplasty and hypospadias correction procedures.