Urethral stricture
The urethra is a canal that connects the bladder to the external environment, passing through the prostate and penis. Urethral stenosis, or urethral narrowing, is the complete or incomplete obliteration of this canal and can occur after prostate surgery, endoscopic surgery to treat kidney stones, use of catheters, genital trauma, balanitis xerotica obliterans and sexually transmitted diseases.
Generally, the patient feels pain when urinating, a thin urinary stream, a sensation of incomplete bladder emptying, increased urinary frequency and frequent nocturnal urination. Extreme cases can lead to acute urinary retention (inability to urinate).
Treatment of Urethral Stricture
In general, the treatment for urethral stricture is surgical, with the main modalities being:
Urethral dilations
In this type of treatment, the urologist inserts several probes into the urethra, widening the canal. This is an old method and is only used in extreme cases, such as in very elderly patients or those with multiple comorbidities that prevent a better quality procedure.
Internal urethrotomy
Method in which the narrowed area is opened internally, with the aid of an endoscope. This technique is also in disuse due to the high rates of recurrence (reappearance) of the stenosis;
End-to-end urethroplasty
Modality in which the narrow area is completely removed and stitched between the two healthy urethral segments. This technique offers the best results, but can only be used in smaller strictures;
Replacement urethroplasty
This procedure is indicated for larger, more complex narrowings in which the narrowed area is replaced with tissue from the patient’s own body. The most commonly used tissues are the mucous membrane of the mouth (skin that lines the inside of the mouth) and the foreskin (skin that covers the penis).
If you’re experiencing some of the symptoms mentioned above or have already been diagnosed with urethral stricture, you should immediately seek advice from a qualified professional. Dr. Luiz Augusto Westin, a doctor specializing in reconstructive urology in Rio de Janeirohas extensive experience in this field.
Hypospadias
Hypospadias is a congenital disease in which the urethral meatus is not located at the tip of the penis and may or may not be accompanied by penile curvature (crooked penis). The urethral meatus can be located anywhere between the glans (head of the penis) and the perineum, close to the anus.
The best time for surgical correction of hypospadias is in childhood, but in adulthood it is very common to find patients with hypospadias who have been operated on multiple times and have complications such as narrowing of the urethra, urinary fistulas (drainage of urine through an unnatural orifice), severe shortening and/or severe penile deformities, among others.
Multiple surgeries and their complications undoubtedly lead to biopsychosocial disorders, given the importance of the penis in our society.
The treatment of hypospadias, whether multi-operated or not, is always multidisciplinary, with the mental health team playing a fundamental role in deciding on the treatment together with the patient and the treating doctor.
When surgical treatment is indicated, various techniques can be used, such as rotation of foreskin flaps, mouth mucosa grafts and techniques to correct the curvature and lengthening of the penis.
Every effort is made to restore the functionality of the penis (the ability to urinate while standing up and to penetrate during sexual intercourse) and with the best possible aesthetics.
Dr. Luiz Augusto Westin specializes in the treatment of hypospadias with or without penile curvature in children and adults and is recognized as one of the leading urologists specializing in reconstructive urology in Rio de Janeiro.
