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Abstract: The patient in this case is a 44-year-old male who suffered from urinary tract infection 2 years ago and improved after local treatment, but his symptoms worsened 4 months ago and he was seen in our outpatient clinic, where he was diagnosed with urethral stricture and underwent cystostomy, but the patient came to the hospital today and indicated that he wanted to undergo surgery, so he was admitted to our department and underwent surgery after completing relevant tests. The patient was discharged 4 weeks after surgery, and the results of the follow-up examination indicated a good recovery.
Basic information】Male, 44 years old
Disease Type】Urethral stricture
Hospital】Xiang Ya Hospital of Central South University
Date of consultation】May 2021
Treatment plan】Surgical treatment (urethroplasty with tipped penile flap) + intravenous infusion (levofloxacin hydrochloride injection)
Treatment period】4 weeks of inpatient treatment and continuous outpatient follow up
Treatment effect]: Urethral stricture was lifted and urination returned to normal after surgery.
I. Initial consultation
The patient, male, 44 years old, complained of incomplete urination, frequent urination, thin urine line, and straining to urinate without visual hematuria two years ago without any obvious cause, so he went to the local hospital and was diagnosed as “urinary tract infection” and given anti-inflammatory treatment (specific medication is not known). The contrast was injected through the urethral orifice, and the urethral spongiosome was stenosed, with the stenosis segment being about 23 mm long. In order to seek surgical treatment, she came to our outpatient clinic, where a physical examination suggested narrowing of the external urethral opening, so she was admitted to our department with urethral stricture in combination with previous examinations, and the next treatment was carried out after perfecting the examination.
II. Treatment history
The patient’s cystourethrography was repeated after admission and showed that the uneven stenosis in the cavernous part of the urethra was slightly more pronounced than before, with the stenotic segment being about 40 mm long and the narrowest segment being about 3 mm wider. the posterior urethra was slightly dilated and no significant segmental stenosis was seen. Compared to the previous findings, the anterior urethral spongiosomal stenosis was slightly more pronounced, while the rest of the condition remained essentially unchanged. Taking into account the patient’s current condition and his own wishes, a surgical approach of urethroplasty with a tipped penile flap was proposed for treatment. The urethral stenosis was excised, and the flap was free to cover the urethral defect, and the flap was sutured to the urethral mucosa at the upper and lower ends, and a support tube was left in place to dress the area with pressure. Postoperatively, levofloxacin hydrochloride injection was given to anti-infection.
III. Treatment results
The patient’s surgery went smoothly, and no complications such as infection and urinary fistula occurred after surgery, and he recovered well. The urethral catheter was removed 4 weeks after surgery, and urinary flow rate examination was routinely performed, which indicated normal urinary function. When the cystoscopy was repeated, the soft cystoscope could be passed smoothly and no stricture was seen at the anastomosis, suggesting good postoperative recovery and release of urethral stricture.
IV. Precautions
After removal of the urinary catheter 4 weeks after surgery, urination was basically normal and the patient’s psychological burden was thus relieved, and I was happy for the success of this operation. However, I did not forget to tell the patient to pay attention to the disinfection of the urethral orifice and the wound, which can effectively reduce the retrograde proliferation of bacteria from the urethral orifice and avoid causing postoperative urinary tract infection and inducing stricture again. After each urination and defecation, the perineum and perianal area should be scrubbed and dried with a soft cloth to keep the area dry and tidy to avoid inducing postoperative infection. In addition, outpatient review every 3 months to check the recovery.
V. Personal insight
The patient in this case is suffering from recurrent UTIs, resulting in scarring of the urethra, which in turn leads to urethral stricture, which is the cause of most patients with urethral stricture. Therefore, patients diagnosed with urethritis should be treated early and standardized. Once symptoms of straining to urinate, painful urination, and incomplete urination appear, you should be highly alert to urethral stricture and promptly visit the urology department to improve relevant examinations and treat them as soon as possible after a clear diagnosis to avoid long-term stimulation of inflammation inducing urethral stricture.