Poor urine flow can be due to obstruction to flow such as a stricture urethra (narrowing in the urine tube) or prostatic enlargement. Occasionally this can be due to weak bladder musculature.
Stricture urethra is a narrowing in the urine tube (urethra) and decreases the urine flow with increased frequency of urination (due to inadequate bladder emptying). Stricture urethra can occur due to lichen sclerosis (a skin disorder affecting the external genitalia), infection, trauma, instrumentation, radiation treatment for prostate cancer or as a result of poor catheterization technique.
Diagnosis of stricture urethra is achieved by performing a retrograde urethrogram (X-ray taken after instilling a small amount of contrast in the urethra) and/or a voiding cystourethrogram (patient is made to pass urine after filling the bladder with contrast and an X-ray is taken). Another method is on visualization of the stricture on direct inspection with a telescope (cystoscopy).
This depends on the cause, location, length of the stricture and the surrounding fibrosis.
The available options include –
Various types of urethroplasty procedures are used to treat stricture urethra –
The exact nature of surgery needs to be discussed with our Urologist.
10% of pelvic fracture cases are complicated by urethral (urine tube) injury. The commonest cause is road accidents. The patient is unable to pass urine or there is blood at the tip of the penis.
Acute management includes bypassing the urine with a tube inserted directly in the bladder (SPC) from the lower part of the abdomen.
A thorough history, examination, erectile function status, retrograde urethrogram (X-ray taken after instilling a small amount of contrast in the urethra) and voiding cystourethrogram (patient is made to pass urine after filling the bladder with contrast and an X-ray is taken), penile doppler (to assess blood flow) is required.
A stepwise approach is utilized to treat PFUI. A perineal incision (cut between scrotum and anus) is utilized and the two ends of the urethra are identified, scar tissue excised and the two ends are joined together over a catheter tube.
Occasionally a combined abdominal and perineal incision is required.