The urologist is the medical specialist for all diseases of the urinary tract.
The urologist should be consulted as soon as any changes become noticeable. When patients report changes in the flow of urine or frequent infections of the urinary tract, the urologist will investigate the presence of a urethral stricture. In many cases however, urethral strictures remain inconspicuous until the onset of acute urinary retention. Until the underlying causes become more specific, the urologist will focus on creating an anamnesis. This involves documenting the patient’s entire medical history and recording detailed descriptions of the physical complaints. Typical questions asked for the anamnesis include the following:
- Have diseases of the urinary tract been diagnosed on previous occasions?
- Have you noticed changes in the flow of urine?
- Have you received invasive examinations or treatments of the urinary tract before?
- Have you had any accidents – including those involving minor injuries to the genital area?
Following the anamnesis, the patient’s urine will be examined. This enables the urologist to rule out the presence of a urinary tract infection. The latter must be ruled out or treated before further diagnostic or therapeutic measures can be taken. Performing these procedures in the presence of an untreated infection of the urinary tract can cause germs to enter the patient’s blood, which in turn can lead to blood poisoning. Thus as a preliminary step, any infections must be ruled out, in order to eliminate the risk of such urosepsis.
The body of the patient will also be examined in detail. On the one hand, any visible external changes to the patient’s body will be assessed. On the other, the urologist will check the patient’s kidneys and record any indications that might point to a urethral stricture. An instrument called a uroflow machine -a specialised type of urinal- is then used to test the flow of urine during urination. It measures the urine stream while the patient is emptying the bladder. In the presence of a urethral stricture, the duration of passing urine will be longer and the urine stream will be noticeably weakened. The bladder is subsequently checked for any retained urine via ultrasound. This procedure doesn’t allow for a direct depiction of the urethral stricture, but the specialist can obtain an accurate image of the patient’s bladder. A urethral stricture can cause the muscle layers of the bladder wall to become thickened. This thickening is the body’s way of compensating for the increased pressure due to the narrowing of the urethra. During the ultrasound examination, special attention is paid to detect any harmful urinary reflux into the kidneys.
On the basis of the test results, the urologist can establish a diagnosis or decide to carry out further tests in order to arrive at a safe diagnosis.
Should the test results confirm the presence of a urethral stricture, then both its precise location and type need to be determined. This may be achieved by performing a procedure known as a retrograde urethrogram. It involves injecting a so-called contrast agent through the opening of the urethra and into the urinary tract. After this, an X-ray image is created which allows the urologist to determine the type and exact location of the urethral stricture.
There are, of course, alternatives to this procedure. In the antegrade urethrogram, the contrast agent is inserted into the bladder via a urethral catheter or direct puncture. The contrast agent can also be introduced into the human body intravenously. However, with the latter technique it takes some time for the contrast agent to arrive at the bladder. In medical jargon the subsequent X-ray examinations are termed micturating cystourethrographies. If the examination fails to provide reliable conclusions regarding the presumed urethral stricture, a urethroscopy is performed. The disadvantage of the urethroscopy consists in its inability to provide information regarding the exact length of the stricture, if the cystoscope fails to negotiate the constricted section. Urodynamic tests are carried out, should the previous tests prove insufficient to arrive at unambiguous results. These involve the use of measurement catheters to precisely analyse the pressure ratios at the rectum and the bladder. In cases of urethral stricture, urologists will always attempt to rule out benign or malignant tumours, for example on the prostate, as these can cause the same complaints. Another possibility consists in foreign objects having entered the urethra and causing the stricture. Such objects might be urinary stones, for example. In cases of unclear test results, urologists will also attempt to rule out the following causes: Sclerosis of the bladder neck, detrusor bladder neck dyssynergia or mealourethra. Prior to arriving at a definitive therapy plan with male patients, urologists will also attempt to establish whether the cavernous bodies are affected by scarring, and if so, determine how far the scarring has progressed.
