Urethral strictures in men: diagnosis

In some cases, with the diagnosis of the stricture of the urethra in men, it is not possible to obtain exhaustive information about the disease. That is why there is a need for additional (optional) studies:

• urethroscopy;
• Cystourethroscopy;
• sonography of the urethra;
• Spongiography;
• Prostate and urethra urinary tract;
• magnetic resonance urethrocystography;
• fistulography.

Urethroscopy is necessary:

• with fuzzy results of retrograde urethrography and antegrade cystourethrography regarding the presence and absence of stricture and its characteristics;
• for unclear reasons for the formation of stricture (idiomatic, urethral cancer, tuberculosis) for mucosal biopsy;
• as a stage of examination of the urethra in front of the internal optical urethrotomy.

Cystourethroscopy is necessary in the presence of a urinary fistula in those cases. When:

1. failed to visualize the urethra by antegrade cystourethrography or by introducing a proximal buzha;
2. there is a suspicion of stenosis of the neck of the bladder;
3. Symptoms and signs of prostate adenoma and possible associated obstruction were noted.

Endoscopic diagnosis of urethral stricture in men allows in all cases to solve diagnostic problems and clarify the tactics of managing the patient. As a rule, they are performed under general anesthesia at the stage of the operation preceding the recovery of the urethra. It is also advisable to use flexible endoscopes (or even children's) under local anesthesia, which causes minimal discomfort.

Contrast urethrography and endoscopy give comprehensive information about the localization, extent and extent of stricture. However, the depth of damage to the spongy body and its density is objectively assessed using palpation of the urethra and urethrocopy is very difficult. To obtain objective information on the length and severity of spongiofibrosis, ultrasound of the urethra and spongeography are performed.

Percutaneous sonography of the urethra and spongiography are indicated for evaluation of spongiofibrosis in the following clinical situations:

• inflammatory stricture, including iatrogenic;
• complicated stricture, including recurrent;
• idiopathic stricture.

Of course, the urologist needs information on the condition of periurethral tissues, which can be obtained with the help of:

• TRUSI prostate (abscess prostate, adenoma);
• percutaneous sonography (paraurethral abscesses, etc.);
• fistulography (assessment of the site of lesions of periurethral tissues);
• MRI with contrast of the urethra and three-dimensional reconstruction in complex cases of bone fractures with distraction ruptures of the urethra and other pelvic organs, repeated relapses of strictures as an alternative to standard urethrography (routine use of MRI in urethral stricture is not recommended).

When examining patients with suspected urethral stricture, other methods of diagnosing urethral stricture in men may be used:

• UFM (in the absence of obliteration):
• Ultrasound of the bladder (residual urine):
• MSCT kidney with contrasting (in the presence of symptoms of kidney damage and upper urinary tract);
• bacteriological analysis of urine, scraping or discharge from the urethra.

It is these studies that make it possible to assess the severity of the clinical course of a stricture disease, defined as:

1. the degree of decrease in the maximum flow of urine:
2. hypoactive detrusor (volume of residual urine):
3. the activity of the infectious process of the urinary tract and genital organs.
4. the spread of obstruction to the upper urinary tract (hydronephrosis, stones, etc.).

Indications for consultation of other specialists

With stricture of the urethra arising from complicated fractures of the pelvic bones, there may be a need to discuss with the orthopedic trauma specialists the terms favorable for performing a plastic surgery on the urethra. Sometimes an operation on the urethra can be delayed due to complications in the treatment of pelvic bone injuries. In the presence of combined damage to the rectum and development of uro-intestinal fistulas, it is necessary to solve joint problems with specialists in the field of coloproctology.

Differential diagnosis of urethral stricture

It is performed with other obstructive diseases of the lower urinary tract (congenital or acquired stenosis of the neck of the bladder, prostatic hyperplasia, chronic prostatitis / chronic pelvic pain syndrome, prostate carcinoma, urethral cancer, urethra stone, specific inflammatory diseases of the urethra (tuberculosis, etc.). In some cases, differential diagnosis of urethral stricture in men with neurogenic lesions of the lower urinary tract she, showing obstructive symptoms of urination.

[1], [2], [3], [4], [5]

Example of the formulation of the diagnosis

• Inflammatory subtotal stricture of the spongy part of the urethra.
• Traumatic (iatrogenic) stricture of the head of the urethra (it should not be indicated because it is always short in this stricture department).
• Idiopathic long stricture bulboznogo department of the urethra.
• Traumatic obliteration of the membranous urethra.
• Traumatic (iatrogenic) long obliteration of the bulbous-membranous prostatic urethra.

[6], [7], [8], [9], [10], [11]