Treating a urethral stricture: dilatation and urethrotomyPeshab ki nali ki tangi ka ilaaj: dilatation aur urethrotomy

Yeh kya hai aur kyun kiya jata hai

Stricture peshab ki nali ka daagh wala, tang hissa hota hai. Is se dhaar kamzor hoti hai, zor lagana padta hai, aur peshab ke infection, bladder ke khali na hone ya bohat bigre mamle mein bilkul peshab na aane ka masla ho sakta hai (dekhein peshab ki nali ki tangi ki guide).

Dilatation mein tang hissay ko khola jata hai, peshab ki nali se guzaray gaye badhte hue size ke patle saliyon (ya balloon) ke zariye. Optical urethrotomy mein patli doorbeen ki nok par chhoti blade ya laser se nazar ke saath daagh ko kaat diya jata hai taake raasta khul jaye. Dono peshab ki nali ke zariye hote hain aur jild par koi cut nahi lagta.

Yeh aam tor par chhoti, pehli baar ki tangi ke liye, ya jab koi bare operation ke liye fit na ho, tajveez kiye jate hain. Aap ka urologist aksar pehle dye wale X-ray (dekhein retrograde urethrogram ki guide) ya camera test (dekhein flexible cystoscopy ki guide) se tangi ka muaina karta hai.

Procedure se pehle

• Pehle peshab ka test hota hai. Peshab ke infection ka procedure se pehle ilaaj hota hai (dekhein peshab ke tests ki guide). Aap ko antibiotic ka course diya ja sakta hai.
• Tests: bahao ka test (uroflowmetry) aur dye wala X-ray batate hain ke tangi kahan aur kitni lambi hai. Apne pehle ke nateeje saath layein.
• Khoon patla karne wali dawayein aur kisi bhi allergy ke baare mein team ko batayein. Apne taur par koi dawa band na karein.
• Bay-hoshi: tangi aur ilaaj ke mutabiq yeh local anaesthetic gel, spinal ya poori bay-hoshi mein ho sakta hai. Khaane peene ke baare mein jo hidayaat milein un par amal karein.
• Aap se razamandi (consent) maangi jayegi. Poochhein ke tangi ke dobara aane ka kitna imkaan hai, aur agla qadam kya hoga.
• Qeemat, procedure kahan hoga aur aap usi din ghar jayenge ya nahi, yeh bhi poochh lein.

Procedure ke dauran

Anaesthetic ke asar ke baad patli doorbeen peshab ki nali se guzar kar tangi tak jati hai. Surgeon ya to dilators se use phailata hai, ya chhoti blade ya laser se daagh ko kaat'ta hai. Phir doorbeen khuli hui jagah se guzar kar bladder tak dekhi jati hai, aur jagah ke bharne tak aam tor par thori der ke liye catheter lagayi jati hai.

Procedure ke baad aur recovery

• Catheter aam tor par chand din rehti hai, kabhi kam kabhi zyada. Team batayegi ke woh kab nikali jayegi (dekhein peshab ki catheter ki guide).
• Peshab mein thoda khoon, jalan aur chubhan chand din se do haftay tak aam hai.
• Bohat paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho. Is se peshab saaf rehta hai aur zakhm bharne mein madad milti hai.
• Khaas hissay ki sakhti kuch der dardnaak ho sakti hai aur kabhi khoon bhi aa sakta hai. Is ke baare mein aur jinsi taluq ke baare mein team se poochhein.
• Sargarmi: roz chalein, lekin thori der ke liye bhaari wazan uthane aur zor wali kasrat se parhez karein, jaisa mashwara ho.
• Khud catheter lagana ya halki khud-dilatation ka silsila kabhi kuch haftay ya mahinay ke liye batayi jati hai taake tangi dobara na aaye. Agar aisa ho to nurse aap ko sikhayegi (dekhein peshab ki catheter ki guide).

Mumkina khatrat aur yeh kitna kaam karta hai

• Sab se bari had yeh hai ke tangi aksar dobara aa jati hai, kyunke daagh dobara tang ho sakta hai. Yeh chhoti, pehli baar ki tangi mein behtar kaam karta hai. Agar aik do baar ke baad tangi wapas aa jaye to yeh ilaaj dohrana zyada der faida nahi deta, aur aam tor par bade operation ka mashwara diya jata hai (neeche dekhein).
• Aam: peshab mein khoon, aur chand din jalan aur takleef.
• Kam aam: peshab ka infection, khoon jis ke liye catheter zyada der rakhni pare, aur kuch der khaas hissay ki sakhti ke saath dard.
• Ghair aam: tangi ka dobara aa jana, aale (instrument) se banne wala jhoota raasta (false passage) jis ka aam tor par catheter se ilaaj hota hai, aur thori der ke liye peshab ka reesna.
• Bohat kam: khaas hissay ki sakhti ya peshab par qaboo mein lambay arsay ki tabdili, taang ya phephre mein khoon ka lothra, ya anaesthetic ke khatrat.

Agar tangi dobara aaye

Bohat si dobara aane wali tangiyon ka behtar ilaaj urethroplasty se hota hai, jo aisa operation hai jis mein peshab ki nali ko tissue se dobara banaya ya chora kiya jata hai, aur aam tor par lambay arsay ke nateeje behtar hote hain. Aap ka urologist is par baat karega, aur tangi ko khula rakhne ke liye baqaida khud catheter lagane par bhi.

Follow-up aur nateeje

• Follow-up visit: aam tor par kuch haftay baad dekha jata hai, aur bahao ka test dobara ho sakta hai (dekhein uroflowmetry ki guide).
• Agar dhaar dobara kamzor ho, ya aap ko zor lagana pare ya baar baar infection ho to jaldi apne urologist ko dikhayein. Jaldi pakri gayi tangi ka ilaaj aasaan hota hai (dekhein kamzor dhaar ki guide).
• Lambay arsay ka follow-up kabhi tajveez kiya jata hai kyunke tangi mahinon ya saalon baad dobara aa sakti hai.

Aam sawalaat

What it is and why it is done

A stricture is a scarred, narrowed part of the urethra. It slows the stream, makes you strain, and can lead to infections, a bladder that does not empty or, in the worst case, being unable to pass urine at all (see the urethral stricture guide).

Dilatation stretches the narrow part open, using a series of thin rods of increasing size (or a balloon) passed along the urethra. Optical urethrotomy uses a thin telescope with a small blade or laser at the tip to make a cut through the scar, under direct view, so the channel opens. Both are done through the urine tube, with no cuts on the skin.

These are usually offered for a short, first-time stricture, or when someone is not fit for a bigger operation. Your urologist will often check the stricture first with a dye X-ray (see the retrograde urethrogram guide) or a camera test (see the flexible cystoscopy guide).

Before the procedure

• A urine test is done first. A urine infection is treated before the procedure (see the urine tests guide). You may be given a course of antibiotics.
• Tests: a flow test (uroflowmetry) and the dye X-ray show where and how long the stricture is. Bring your earlier results.
• Tell the team about blood thinners and any allergies. Please do not stop any medicine on your own.
• Anaesthetic: this may be done under local anaesthetic gel, a spinal anaesthetic or a general anaesthetic, depending on the stricture and the treatment. Follow the instructions about eating and drinking.
• You will be asked for consent. Please ask how likely the stricture is to come back, and what the next step would be.
• Ask about the cost, where it will be done and whether you will go home the same day.

During the procedure

With the anaesthetic working, a thin telescope is passed along the urethra up to the narrowing. The surgeon either stretches it with dilators, or cuts through the scar with the small blade or laser. The telescope is then passed through the opened area to look into the bladder, and a catheter is usually left in for a short time while the area begins to heal.

After the procedure and recovery

• The catheter usually stays in for a few days, sometimes less or longer. The team will tell you when it will be removed (see the urinary catheter guide).
• Some blood in the urine, burning and a stinging feeling are common for a few days to a couple of weeks.
• Drink plenty of water unless told otherwise. This keeps the urine clear and helps healing.
• Erections can be painful for some time, and sometimes bleeding can happen. Ask the team about this and about sex.
• Activity: walk daily, but avoid heavy lifting and strenuous exercise for a short time, as advised.
• Passing a catheter yourself or a gentle self-dilatation routine is sometimes advised for a few weeks or months to help stop the stricture coming back. The nurse will teach you if so (see the urinary catheter guide).

Possible risks and how often it works

• The main limitation is that the stricture often comes back, because the scar can tighten again. It works better for a short, first-time stricture. If it comes back after one or two of these treatments, repeating them is unlikely to help for long, and a bigger operation is usually advised (see below).
• Common: blood in the urine, burning and discomfort for a few days.
• Less common: a urine infection, bleeding that needs a longer catheter stay, and pain with erections for a time.
• Uncommon: the stricture coming back, a false passage made by the instrument (usually treated with a catheter), and temporary leaking of urine.
• Rare: a lasting change in erections or bladder control, a blood clot in the leg or lung, or the risks of the anaesthetic.

If it comes back

Many strictures that come back are better treated with urethroplasty, an operation that reconstructs or widens the urethra with tissue, usually with better long-term results. Your urologist will discuss this, as well as the option of regular self-catheterisation to keep a stricture open.

Follow-up and results

• Follow-up visit: you will usually be seen some weeks later, and a flow test may be repeated (see the uroflowmetry guide).
• If the stream weakens again, or you strain or have repeated infections, see your urologist early. A stricture that is found early is easier to treat (see the weak stream guide).
• Long-term follow-up is sometimes advised, because a stricture can come back months or years later.

Common questions