TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Urethral Strictures An information guide
hat is a urethra? he urethra is the tube or waterpipe through which urine flo rom the bladder to the outside of the body; the opening of he urethra Urethal is Strictures at the end of the penis in men and just above th aginal opening in women. What is a urethra? The urethra is the tube or waterpipe through which urine flows from the bladder to the outside of the body; the opening of the urethra is at the end of the penis in men and just above the vaginal opening in women. hat is a urethral stricture? stricture What is a is urethral a narrowing stricture? of the urethra, and can occur at any ection of the urethra. There is usually some scar tissue around A stricture is a narrowing of the urethra, and can occur at any he affected section of the part urethra. of the There urethra is usually that some causes scar tissue the narrowing. around the Th ength affected of the part strictures of the urethra can that vary, causes from the less narrowing. than 1cm The or length longer nd of they strictures are generally can vary, more from less common than 1cm in or men longer than and women. they are Th an generally occur at more any common age and in it men is possible than women. to They have can more occur than at anyone age and it is possible to have more than one stricture. tricture. 2 2
What causes a urethral stricture? injury or damage to the urethra is the most common cause of strictures. This can result in scar tissue forming at the site of the injury, resulting in a narrowing. For example an injury may occur during medical procedures to look into the bladder via the urethra; radiotherapy treatment may cause damage to the urethra; a fall astride onto the frame of a bike can cause damage a less common cause of urethral strictures is infection. This could include sexually transmitted infections such as gonorrhoea or chlamydia, or infection as a complication of long term use of a catheter to drain the bladder. Infection may cause inflammation in the tissues in and around the urethra which can result in scar tissue being formed at the site of the inflammation in the urethra, causing a stricture. What are the symptoms? The symptoms may be varied but can include the following:- reduced urine flow or straining to pass urine spraying of urine or a double stream dribbling of urine for a while after going to the toilet to pass urine needing to pass urine more often than normal mild pain on passing urine. 3
What are the possible complications? more pressure is required from the bladder muscle to squeeze the urine through the stricture, as it acts like a bottle neck incomplete bladder emptying resulting in pooling of urine within the bladder, making you more prone to waterworks infections rarely abscesses (balls of infection) can form above the stricture causing further damage to the urethra and tissues below the bladder cancer of the urethra is an extremely rare complication of a longstanding stricture. What tests are required? flow test You will be asked to pass urine into a special machine where the time it takes to pass urine is measured. The flow rate is much reduced if you have a stricture. Following this you will have a bladder ultrasound scan to check you are emptying your bladder well X-Ray A special x-ray may be required to determine how long the stricture is and how severe it is cystoscopy A look into the urethra by a special thin telescope may be needed to see if there is a stricture present. What is the treatment for urethral strictures? Treatment is usually advised to improve the flow of urine, ease symptoms and to prevent the occurrence of possible complications. A specialist surgeon called a urologist normally advises on the treatment required. The most common treatment options are urethral dilatation (widening of the stricture), or urethrotomy (cutting along the stricture), both of which will be discussed in greater detail. 4
Urethral dilatation What is a urethral dilatation? This is the most common form of treatment for a stricture along the waterpipe. This is generally done under a general anaesthetic and involves passing a thin plastic or metal rod into the urethra. Rods of increasing thickness are gently inserted to gradually widen the narrowed stricture. The aim is to stretch the stricture without causing any additional scarring. Once the urethra as been stretched the bladder is usually examined using a telescopic instrument. What are the benefits? It will help relieve a urinary obstruction due to a stricture and improve your urinary flow. Also it will result in complete bladder emptying, hence reducing the risk of urinary tract infections. What are the alternatives? observation by monitoring the patient s flow rate or their symptoms becoming worse an Optical Urethrotomy internal cutting of stricture (described on page 8) urethroplasty open repair of the stricture Possible risks All procedures carry some risks with this type of procedure you can experience:- passing urine more often (frequency) discomfort on passing urine slight blood in the urine urine infection recurrence of the stricture, requiring further procedures or a repeat incision. For this reason you may be taught to self-dilate the 5
stricture with a self-lubricated catheter. If the doctor feels that this is a suitable treatment you may be taught how to do this by a urology specialist nurse before/ after leaving hospital. Before the operation you will be asked to attend the Pre-operative clinic you will be advised when to stop eating and drinking before your operation if you are taking anti-coagulants (warfarin, aspirin, clopidogrel or sinthrone) please inform the Pre-op assessment staff you may be asked to sign your consent form after being fully informed about the procedure What happens on your operation day? you will be asked relevant information by the nurse and a doctor you may be seen by an anaesthetist your operation will be explained to you and you will be asked to sign a consent form, if you have not already done this. What happens after your operation? you may require oxygen following your operation your blood pressure, temperature, pulse and respiration rate will be recorded by the nurse you may experience some pain and discomfort after surgery. Pain relief will be provided by the nurses you should be able to eat and drink normally once the anaesthetic has worn off you may have a catheter in for a short time (usually 2-3 days).this is a tube which lies inside your bladder and drains your urine into a bag. 6
When you are ready to go home you may go home with a catheter in your bladder. You will be taught how to look after it and arrangements will be made for you to have it removed the nursing staff will make sure that you are passing adequate volumes of urine naturally after the operation. If you have had a catheter in, the doctors will decide when this is to be removed and you will be assessed for passing urine naturally prior to going home after its removal your doctor and nurse will discuss when they are happy for you to go home you may have been asked to stop taking some medication prior to your operation. If so, please ask your hospital doctor about restarting these before you can go home you may be referred to a urology specialist nurse to be taught the procedure of self-dilatation using catheters which will help in preventing the stricture from recurring ideally you need to avoid driving to start with and slowly build up your time and distance over the next few weeks returning to work depends upon the nature of your work. You will need to seek advice from your consultant s team of doctors if you require a sick note to cover your hospital stay, please ask the nurses on the ward appropriate arrangements will be made for your follow up If you are discharged on the day of your operation after having a general anaesthetic you are advised for the next 24 hours: not to return to work not to sign any important documents not to drive as your insurance will be invalid 7
you will need to have a responsible adult to look after you; they will also need to accompany you home after your operation. This will be discussed with you at the pre-operative assessment clinic If you are worried or have problems after your discharge, contact your GP or telephone the ward for advice. In an emergency, go to the nearest Accident & Emergency department. Optical urethrotomy What is an optical urethrotomy? An optical urethrotomy is a procedure for the opening up of a stricture (narrowing), which consists of scar tissue in the urethra (water pipe). This is cut internally, using a blade or laser, with the use of a special telescope which is passed down the penis. The operation is usually performed under a general anaesthetic. What are the benefits? It helps to relieve your urinary obstruction and improve your urinary flow. It will also help to improve bladder emptying, hence reducing the risk of urinary tract infection. What are the alternatives? observation by monitoring the patient s flow rate or worsening of symptoms urethral dilatation - widening of the water pipe urethroplasty open repair of the stricture Possible risks All procedures carry some risks with this type of procedure you can experience:- passing urine more often (Frequency) discomfort on passing urine slight blood in the urine 8
urine infection recurrence of the stricture, requiring further procedures or a repeat incision. For this reason you may be taught to self-dilate the stricture with a self-lubricated catheter. If the doctor feels that this is a suitable treatment you may be taught how to do this by a urology specialist nurse before/ after leaving hospital. Before the operation you will be asked to attend the Pre-operative clinic you will be advised when to stop eating and drinking before your operation if you are taking anti-coagulants (warfarin, aspirin, clopidogrel or sinthrone) please inform the Pre-op assessment staff you may be asked to sign your consent form after being fully informed about the procedure. What happens on your operation day? you will be asked relevant information by the nurse and a doctor you may be seen by an anaesthetist your operation will be explained to you and you will be asked to sign a consent form, if you have not already done this. What happens after your operation? you may require oxygen following your operation your blood pressure, temperature, pulse and respiration rate will be recorded by the nurse you may experience some pain and discomfort after surgery. Pain relief will be provided by the nurses you should be able to eat and drink normally once the anaesthetic has worn off 9
you may have a catheter in for a short time (usually 2-3 days).this is a tube which lies inside your bladder and drains your urine into a bag. When you are ready to go home you may go home with a catheter in your bladder. You will be taught how to look after it and arrangements will be made for you to have it removed the nursing staff will have to make sure that you are passing adequate volumes of urine naturally after the operation. If you have had a catheter in, the doctors will decide when this is to be removed and you will be assessed for passing urine naturally prior to going home after its removal your doctor and nurse will discuss when they are happy for you to go home you may have been asked to stop taking some medication prior to your operation. If so, please ask your hospital doctor about restarting these you may be referred to a urology nurse specialist to be taught the procedure of self-dilatation using catheters, which will help in preventing the stricture from recurring you need to avoid driving for one week you need to avoid heavy lifting for 2 weeks returning to work depends upon the nature of your work. You will need to seek advice from your consultant s team of doctors if you require a sick note to cover your hospital stay, please ask the nurses on the ward. Any further sick notes can be obtained from your GP appropriate arrangements will be made for your follow up 10
if you are discharged on the day of your operation after having a general anaesthetic you are advised for the next 24 hours; not to return to work not to sign any important documents not to drive as your insurance will be invalid you will need to have a responsible adult to look after you; they will also need to accompany you home after your operation. This will be discussed with you at the pre-operative assessment clinic If you are worried or have problems after your discharge, contact your GP or telephone the ward for advice. In an emergency, go to the nearest Accident & Emergency department. 11
If English is not your frst language and you need help, please contact the Ethnic Health Team on 0161 627 8770 Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu 0161 627 8770 For general enquiries please contact the Patient Advice and Liaison Service (PALS) on 0161 604 5897 For enquiries regarding clinic appointments, clinical care and treatment please contact 0161 624 0420 and the Switchboard Operator will put you through to the correct department / service Date of publication: December 2008 Date of review: February 2014 Date of next review: February 2017 Ref: PI_SU_499 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests www.pat.nhs.uk