Urethral Stricture Treatment in Hyderabad, India | Cost & Benefits

The urologist first initiates the diagnosis of urethral strictures by seeking the patient’s past medical history, physical examination followed by laboratory tests and imaging tests. When diagnosing urethral strictures, blood tests may not be considered relevant.

History

Before initiating the physical examination, the urologist may ask thorough history of the patient, and pay close attention to any symptoms that arise after diuresis (such as after consuming alcoholic or caffeinated beverages). May ask information regarding if there has ever been radiation treatment, surgery, or a previous cancer.

Physical examination of urethral strictures

The urologist may conduct a thorough examination even though the physical examination is typically nondiagnostic. The doctor will palpate the urethra, feel for any palpable fibrous tissue, and check for any changes in the skin, such as pale patches that could be signs of lichen sclerosis, during the physical examination. These patches may occasionally be limited to the region right around the urethral meatus. The urologist may also find any scars that would indicate prior surgery. The urologist may also perform prostate examination that is crucial for detecting benign prostatic hyperplasia (BPH), prostatic cancer, and prostatitis.

Important physical examination findings include abdominal pain, fullness or tenderness, and costovertebral angle tenderness.

Laboratory tests

Uroflowmetry post-void residual estimation

Urine flow is measured using uroflowmetry. It records the amount, time, and speed at which urine flows out. This test evaluates the urinary tract's overall function.

The constrictive blockage brought on by urethral stricture is characterised by a decreased maximum flow rate and a prolonged plateau. Interpreting flow patterns, however, is considered subjective and unreliable as a screening method for stricture identification.

Urinalysis and urine culture

A urine analysis is an essential aspect of the patient evaluation process to determine the lower urinary tract symptoms of a patient which may be signs of urethral stricture disease. If an infection is suspected urine culture should be carried out to confirm the diagnosis, identify the causal organism, and determine antibiotic sensitivity. In order to prevent peri-operative sepsis, bacteriuria should be addressed prior to surgical intervention.

Imaging tests

• Cystoscopy: It is somewhat simple and uncomplicated investigative method to accurately and rapidly identify urethral strictures. It can be quickly completed in a clinic setup under local anaesthesia. It provides the possibility for early therapy by dilation, reduces unwanted delays for diagnosis, promptly validates the diagnosis, and locates the stricture's distal site. Its applicability is restricted when the cystoscope can't enter the stricture site to measure its length or examine the condition of the proximal urethra.

• Retrograde urethrography: This procedure can see the patient's whole urethra all the way up to the bladder with enough relaxation of patient. It might not be possible to determine the extent of a significant stricture if the retrograde urethrogram fails to show enough proximal urethral distention. In these kinds of situations, a voiding cystourethrography (VCUG) will give important and required further information. This can be accomplished by inserting contrast through a suprapubic catheter or by requesting the patient to void after the retrograde urethrogram fills their bladder with contrast material. The whole urethra can be clearly visualised using a simultaneous cystogram, or VCUG, and retrograde urethrogram.

• Ultrasonography: Ultrasonography primarily evaluates the upper urinary system and bladder. It can demonstrate a thicker wall of the bladder, although it cannot directly visualize a stricture, however it helps assess the degree of spongiofibrosis (scar tissue of the corpus spongiosum, that surrounds the urethra).

• Magnetic resonance imaging (MRI): Using MRI scans to detect small urethral strictures is quite unclear. Nevertheless, MRI urethrography is a potent imaging technique that has been researched for many years to assess urethral stricture illness.
  

Differential diagnosis of urethral strictures

Many additional diseases can present in the same way as urethral strictures, which usually do so with developing obstructive symptoms. The differential diagnosis consists of:

• Bladder stones
• Detrusor decompensation or hypotonicity
• Central and peripheral neuropathies such as detrusor sphincter dyssynergia
• Drug-related effects
• Enlarged prostate gland, either benign or cancerous. (prostate enlargement is the most common reason for weak urinary stream) 
• Prostatitis (inflammation of the prostate gland) which would usually be associated with burning, frequency, urgency, haematuria, deep perineal pain especially when sitting, and cloudy urine with a high prostate-specific antigen (PSA)
• Posterior urethral valves
• Underactive bladder
• Urethral stones
• Vesicoureteral reflux
  

Before going for a surgical management of urethral stricture the surgeon may consider the factors such as:

• Patient selection
• Perioperative considerations

Patient selection

To optimize the likelihood of a successful outcome in the treatment of urethral stricture, careful consideration of the patient and the appropriate surgical method are crucial. Stricture cause, location, and severity; previous therapy; comorbidities; and patient preference are the primary elements to take into account while making a decision regarding the selection of surgical intervention.

Before undergoing any surgical interventions, surgeons should take the patient's objectives, preferences, comorbidities, and surgical suitability into consideration.

Perioperative considerations

• The urologist may prescribe an appropriate antibiotic to minimize surgical site infections prior to beginning surgical therapy of a urethral stricture.
• Prior to urethral stricture intervention, active urinary tract infections (UTIs) need to be treated, and preoperative urine cultures are advised to help guide the choice of antibiotic.
• Antibiotics could be stopped within 24 hours or after a single dose to prevent bacterial resistance. 
• In case of an ongoing UTI or an implanted catheter, antibiotics may be continued.
• When it comes to managing endoscopic urethral strictures, oral fluoroquinolones are more economical than intravenous cephalosporins.
• For patients with specific risk factors, antimicrobial prophylaxis is advised at the time of urethral catheter removal.
• Using the lithotomy posture (normal position for medical examinations and surgeries involving the lower abdomen and pelvis) requires careful positioning of the extremities to prevent pressure on the ulnar nerve, peroneal nerve, and calf muscles.
• To lessen the risk of deep vein thrombosis and nerve compression damage, sequential compression devices might be used.
• In some cases, perioperative parenteral deep vein thrombosis prevention is considered during open reconstruction.