Sténose de l'urètre

The causes of urethral stricture

The male urethra is a duct that leads from the bladder to the end of the rod and which carries the semen and urine. Because of its fragility, local lesions can cause shrinkage. This pathology called “urethral stricture” is more frequently observed; it should be treated in order to avoid complications. Its causes are mainly iatrogenic or traumatic. They can also be infectious (but much more in developing countries), or, rarely, congenital. The cause of a number of these narrowings of the urethra remains unknown.
Note: The terminology regarding urethral anatomy is defined in this article.

 

1) Urethral stricture – iatrogenic causes

They are the most common in France (from 30 to 40%), because it is through the urethra, fragile and susceptible to attacks that are practiced endoscopic surgical procedures on the bottom as the upper urinary tract. False roads over the urethral surveys (including self-surveys performed in the intermittent catheterization) are also an important factor of the occurrence of a subsequent urethral stricture.

These strictures are most often located at the urethral meatus or more fixed or narrow duct portions.

It should be noted that the possible healing of defects related to the treatment of these strictures are likely to promote recurrence.

2) Urethral stricture – Unknown causes

Such cases are quite common in France (from 30 to 40%); they may sometimes be linked indirectly to small local physical trauma occurred in childhood.

3) Urethral stricture – Traumatic causes

Injuries account for a less frequent cause urethral stricture, about 15% of cases (up to 35% in some series).

Traumatic strictures are often seen in association with pelvic fractures (by effect of the movement of the hip bone), often in the context of multiple trauma of the public road.

They may also be secondary to direct trauma to the perineum as seen in the classic fall astride.

 

 

Rupture de l'urètre par fracture du bassin

 

Sometimes, but rarely, such stricture are linked to patient because of trauma, due to sex or individual psychiatric disorders. In this case, the seat is usually at the anterior urethra. Here piercing “Prince Albert”

 

Prince albert

 

The pelvic fracture is associated with rupture of the posterior urethra, while perineal trauma rather affects the membranous or bulbar portion of this body.

 

4) Urethral stricture further to infectious diseases

Urethritis (inflammation with abnormal discharge from the urethral meatus) rarely causes stricture, except when it results from a gonococcal infection (or gonorrhea) badly treated.

Infections represent a cause infrequent in industrialized countries because they are rare and well cared for. They are much more common in developing countries, because of their access to care issues. They thus remain the leading cause of stricture in Africa, because of the frequency of genitourinary infections treated badly: these diseases are mostly infectious y (45%) and iatrogenic and unknown causes (20% each), and finally trauma (15%).

Inflammatory diseases of the prostate or the prepuce infection are more rarely possible factors of infection.

Any urethral tumor, cancerous or not, is also likely to cause urethral stricture.

Infectious strictures affecting the anterior urethra (penile or bulbar). They may be compounded by local trauma associated with endoscopic procedures they generate.

 

5) Urethral stricture – congenital causes

These strictures are very rare and are located mostly in the posterior urethra, or urethral meatus. They may be late in adulthood and are fairly well tolerated.

There are three particular forms of congenital strictures:

  • hypospadias (when the urethral opening is abnormally arranged an interview to the ventral side of the penis)
Hypospadias
  • the posterior urethral valves in the form of two recesses of the urethral mucosa is déplissant urination they block
  • urethral duplication (very rare urologic malformation sitting at the bulbar urethra anterior).

 

Some bibliographical elements:

(English)

http://www.urethralcenter.it/English_version/pagine/eziologia_stenosi.html

http://www.amepc.org/tau/article/viewFile/3755/4696

http://www.sciencedirect.com/science/article/pii/S1110570412000100

 

(French)

http://documentation.ledamed.org/IMG/html/doc-10378.html

http://www.dematice.org/ressources/DCEM2/urologie/D2_uro_008/co/document.pdf

http://www.unige.ch/cyberdocuments/theses2002/FleuryN/these_body.html

http://www.revmed.ch/rms/2012/RMS-365/Sondage-transuretral-chez-le-sujet-masculin-prevention-et-traitement-de-l-iatrogenie

http://webcache.googleusercontent.com/search?q=cache:Y95THvUOJKwJ:revue-uroandro.org/index.php/uro-andro/article/download/18/17+&cd=8&hl=fr&ct=clnk&gl=il