By Author
  By Title
  By Keywords

May 1985, Volume 35, Issue 5

Original Article

Uretheral Strictures in Females

Masood A. Sheikh  ( Department of Nephrourology, Jinnah Postgraduate Medical Centre, Karachi. )
S. Ali Jaffar Naqvi  ( Department of Nephrourology, Jinnah Postgraduate Medical Centre, Karachi. )

Abstract

Forty two females ranging in age from 2 years to 76 years were seen over an 18 months period with uretheral strictures. In adults (over 14 years) the prevalent symptom was increased frequency of micturation followed by dysuria, urgency and other symptoms of urinary tract infection (UTI). Thirty percent presented with Acute retention of urine.
In children (under 14 years) presenting with U.T.I, IVP was diagnostic (the most significant investi­gation) showing post micturation residual urine and/or trabeculated bladder with other back pressure effects. Treatment was a simple procedure of uretheral dilatation. A success rate of over 70% was seen with symptomatic improvement.

Introduction

Uretheral strictures are well recognized in males but aie comparatively uncommon in females. Patients present with symptoms of UTI and are treated as such. In our culture women tend to present late when urinary frequency interferes with religious duties and social life. rnvestigation of the underlying cause of U.T.I. and increased urinary frequency may reveal a uretheral structutre. The present study evaluates the usefulness of ure­theral dilatation in females with strictures.

Material and Methods

Forty two females seen over an 18 month period were analysed.
Their clinical features were recorded. Investigations included blood count, BUN and Serum creatinine, urine examination along with colony count and an WP. Panendoscopy was done in only 59% cases. Uretheral calibration was carried out prior to dilatation. The calibre of the urethera was noted in terms of the largest noted dilator which could be passed without the instrument hanging on withdrawal.
Immergut et al. Calibrated uretheras in a group of girls without urinary tract disease and established the following normal measurements 15F for less than 4 years; 17F for 5 9 years and 21 F for 10 - 14 years.     
A Uretheral stricture is diagnosed in adults if a 20F dilator cannot be passed freely.2
Uretheral dilatation was done with graduated metal bougies upto 26F in children (under 14 years) and 38F in adults (over 14 years).

Results

The ages ranged between 2 to 76 years. Symptoms and Signs are shown in following Table.


The haematological and biochemical blood investigations were within normal limits.
Urine cultures were positive in 27 or 64% cases the prevalent organism being E. Coli, staph. aureus and Klebsiella.
The intravenous pyelograrn was the most helpful diagnostic test showing residual urine in all patients presenting without acute retention. Other findings included trabeculated bladder, hydronephrosis, with hydroureter and pyelonephritis in long standing obstruction (Fig 1,2,3).




Only a fine metal probe could be passed in females with acute retention. In children calibre was not larger than 8F and in adults 12F.
Satisfactory results were achieved with dilatation. Followup has been from 3 months to one year.
Of the 13 patients with acute retention of urine 11 have been able to urinate and did not develop retention again. Of the other 29 all had amelioration of symptoms initially except 2 who were considered failures. Four cases required redilation within six months. Two patients died, 1 from septicaemia due to an indwelling catheter and another from complications of hypertension.
Post dilation I.V.P. are shown in Fig. 4 and 5.


Discussion

The majority of female patients with uretheral strictures present with urinary frequency due to inadequate emptying. Unless investigated they may be treated simply with urinary antisaptic and antibiotics with little improvement. Thirty percent of patients in the present series presented with acute retention.
Childrepresent with symptoms of UTI. The child cries a lot and may wet her clothes during the day Others have noctural enuresis3.
Utetheral dilatation is a simple procedure which can be carried out even under local anesthesia and as an out patient. The diagnosis should be based on 1VP and calibration. The female Uretheral Syndrome which gives the same set of symptoms should be differentiated.4 The urological examination in the latter is typically negative and uretheral dilatation gives no relief.

References

1. Campbell, M.F. Urology. 4th ed. Edited by Harrison, J.H. et al. Philadelphia, Saunders, 1979; p. 1657.
2. Bailey, H. Short practice of surgery 17th ed. Rev, by AJ. Harding Rains and H. David Ritchie London, Lewis, 1977; p. 1279.
3. Brannan, W., Ochsner, M.G., Kittredge, W.E., Burns, E. and Medeiros, A. Significance of distal urethral stenosis in young girls; experience with 241 cases. J. Urol., 1969; 101 570.
4. Kaplan, W.E., Firlit, CF. and Schoenberg, H.W. The female urethral syndrome; external sphincter spasm as etiology. J. Urol., 1980; 124 48.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: