Do you sometimes have difficulty starting to urinate, or feel like your urethra is narrow? Do you sometimes feel like there is still urine after you finish urinating, or that you have not completely passed out? Don't ignore these things as normal. Because they can be symptoms of an underlying health problem. Today we are going to talk about a condition that affects men more than women, but can be completely cured if recognized and treated in time. This is called Posterior Urethral Stenosis (PUS) .
What is Posterior Urethral Stenosis?
Simply put, this is a narrowing or constriction in the posterior part of your urethra, the tube that carries urine from your bladder to your body. The word "stenosis" means narrowing. It is sometimes called a "urethral stricture."
Now, what is this "posterior urethra"? This is the part of the urethra closest to your urinary bladder. Specifically, it includes the bladder neck, the external urethral sphincter muscle, which is a muscle that controls urination, and the prostate gland. A man's urethra is usually 8 to 9 inches (about 20 centimeters) long. In a woman, it is only 1.5 inches (3-4 centimeters). So, the upper part of this long urethra in men, that is, the 1-2 inches closest to the bladder, is called the posterior urethra.
When the urethra becomes blocked in this way, especially if it is severely blocked, it can be very difficult to pass urine. Sometimes, you may even be unable to urinate at all.
Who is most likely to see this condition?
Posterior Urethral Stenosis is actually more common in men than women. The reason for this is that, as I mentioned earlier, the urethra in men is longer. Also, this condition may be related to the possibility of men developing prostate-related problems.
How common is this situation?
This is not a very common condition. Most often, it occurs after treatment for another condition in that area. Think of it as prostate cancer treatment, or after a major accident in that area. Very rarely, this condition can be present from birth. We call it ``congenital''. This condition is very rare among women.
What are the symptoms? See if you have these too...
Take a look to see if you have one or more of these symptoms:
- Difficulty urinating: This is the main symptom.
- Urinary tract narrowing and weakness.
- Less urine output than normal.
- The feeling that the bladder has not been completely emptied even after urinating ( Urinary Retention ).
- Pain when urinating (Dysuria).
- Frequent urinary tract infections (UTIs) .
- Prostate Infection.
- Dark urine or blood in the urine (hematuria).
- Abdominal pain.
Even if you have one or two of these symptoms, don't ignore them and wonder, "What is that?" It's best to seek medical advice.
Why is this happening? What are the reasons?
As I mentioned before, this condition can very rarely be congenital. But most of the time, it occurs as a result of an accident, a medical examination, or treatment performed in that area. Here are a few examples:
- Pelvic fracture is a fracture in the pelvic area that causes damage to the urinary tract. Imagine, something like this could happen if someone falls from a height or in a car accident.
- Treatments for Prostate Cancer :
- Radiation Therapy
- Seed implantation (Brachytherapy)
- External Beam Radiation Therapy (EBRT)
- Prostatectomy
- Surgery for Benign Prostatic Hyperplasia (BPH) . An example is a surgery called Transurethral Resection of the Prostate (TURP) .
For reasons like these, the urinary tract is injured, and when those injuries heal, scar tissue forms, causing the urethra to become blocked.
Can this condition get worse if left untreated?
Yes, absolutely. If Posterior Urethral Stenosis is not treated properly, it can get worse over time. This can lead to serious conditions such as:
- Frequent urinary tract infections (UTIs).
- Permanent damage to the bladder.
- Vesicoureteral reflux is the backward flow of urine from the bladder to the kidneys. This is like water leaking back out of a pipe that is supposed to go only one way.
- Kidney damage. This is very dangerous.
Therefore, it is very important to see a doctor as soon as you notice the symptoms. This can help prevent serious complications like these.
How do doctors diagnose this?
When you go to see a doctor, he or she will first ask about your medical history, ask about your symptoms, and then perform a physical examination. In addition, they may also order several tests to confirm the diagnosis:
- X-rays.
- Ultrasound tests.
- Cystoscopy: This involves passing a thin tube with a small camera attached through the urethra to examine the inside of the urethra and bladder. Although it may feel a little uncomfortable, this can help to see exactly where the blockage is and what it is like.
- Retrograde Urethrogram: This is also an X-ray test. Here, a special substance (contrast dye) is injected into the urethra and X-ray images are taken. This allows any blockages in the urethra to be clearly seen.
- Voiding Cystourethrogram (VCUG): This involves filling your bladder with a special substance and taking X-rays while you urinate. This can help to see how your urine flows, whether there is any blockage, or whether urine is flowing backwards (reflux).
After these tests, the doctor can tell you exactly whether you have Posterior Urethral Stenosis , and if so, to what extent.
Can Posterior Urethral Stenosis be completely cured?
Yes! This is the best news. This condition can be cured if diagnosed correctly and treated appropriately. So there is no reason to fear.
How is this treated?
Treatment depends on the cause, the amount of scar tissue, and the length of the blocked area. There are currently no medications available for this. There are two main treatment options:
1. Urethral Dilation:
- This involves using long, thin instruments (rods) or something like a balloon to gradually widen the blocked part of the urethra.
- This is a relatively simple, minimally invasive procedure.
- But this is not a permanent solution . It can get stuck again after a while. So you may have to do this treatment several times.
2. Urethroplasty:
- This is a surgery . This surgery either repairs the damaged, blocked part of the urinary tract, or removes that part and uses healthy tissue to repair the damage.
- This is a method that gives more successful results than the above-mentioned `(Urethral Dilation)` method. The success rate is more than 80%. However, since it is a surgery, there is some risk and it takes some time to recover.
Your doctor will assess your condition and decide which treatment option is best for you.
What complications can occur after treatment?
Even after treatment, there is a chance that Posterior Urethral Stenosis will recur. That's why it's important to keep going for follow-up appointments as your doctor recommends. This way, you can see if you're getting better and if there are any signs of the problem recurring.
Urethral Dilation (UD) may need to be repeated several times, but the success rate of Urethroplasty is very high.
How quickly will I feel better after treatment?
Most people start to feel better within a week after having a ``Urethral Dilation''. However, it can take two to three weeks to fully recover from a ``Urethroplasty'' surgery.
Are there ways to protect yourself from this situation? (Prevention)
It's difficult to prevent all the factors that contribute to this. For example, things like cancer treatment can be done if necessary. However, you can reduce your risk of this condition by trying to avoid injuries, especially to the pelvic area .
Here are some things you can do about it:
- Wear a seatbelt whenever you are riding in a vehicle.
- Wear appropriate protective padding/equipment in high-impact sports (e.g. hockey, football, karate, lacrosse).
- Follow a diet that promotes strong bones. Eat foods rich in calcium and vitamin D.
- Ask your doctor about medications like bisphosphonates that reduce bone loss.
- Do bone-strengthening exercises, especially weight-bearing activities.
- Quit smoking and limit alcohol consumption. Smoking and heavy alcohol consumption can affect your bone density.
What happens if this condition exists? What is the future? (Prognosis)
The outlook for Posterior Urethral Stenosis is generally good. Treatment can widen, repair, or remove the blocked urethra. However, as I mentioned earlier, this condition can recur. Therefore, it is important to continue to have regular checkups as directed by your doctor.
When should I see a doctor?
If you experience any symptoms of posterior urethral stenosis (PUS) , especially a change in urination pattern or a change in the appearance of your urine, be sure to see a doctor.
When do you need to go to an Emergency Treatment Unit (ETU) ?
If you have any of these symptoms, go to the nearest emergency room as soon as possible:
- A condition in which it is completely impossible to urinate.
- The pain becomes worse when urinating.
- Blood in the urine.
- Signs of an infection (e.g. fever, chills, extreme fatigue).
What questions should you ask your doctor?
It's a good idea to ask these questions when you go to the doctor:
- How do you know for sure that I have posterior urethral stenosis?
- What could be the reason why this happened to me?
- How bad is my urinary tract blockage? / How far along is it?
- How should I take care of my health with this condition?
- What treatment do you recommend for me?
- What are the risks and benefits of each treatment method?
- How often should I come for follow-up?
- Do you think this situation will happen to me again?
- Is there anything I can do to prevent this from happening again?
- Can you recommend a specialist (Urologist) for me regarding this?
What is the difference between 'Urethral Stricture' and 'Stenosis'?
"Stricture" and "stenosis" are both terms used by doctors to describe a narrowing or blockage of a passageway or opening. There is a slight technical difference. Urethral stricture is a narrowing of the part of the urethra that passes through the corpus spongiosum, which is located on the underside of the penis. Stenosis usually refers to a narrowing of the part of the urethra that passes through the prostate or the bladder neck. Posterior urethral stenosis is one such condition.
Finally, take-home message
Posterior Urethral Stenosis (PUS) is a rare condition that can affect anyone. However, it is most common in men. It is caused by scar tissue forming in the upper 1-2 inches of the urethra, closest to the bladder. This can cause embarrassing and painful urination problems.
But, you don't have to live with these problems. Posterior Urethral Stenosis is a treatable condition, and the success rate of treatment is very high.
If you have any of these symptoms, especially after a pelvic injury or other related treatment, be sure to talk to a doctor. Early detection can make treatment easier and recovery quicker.
` Urethral obstruction, Posterior Urethral Stenosis, Difficulty urinating, Men's health, Prostate, Urinary diseases
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