Other Diseases

What are Urethral Strictures?

Strictures or urethral narrowing are areas where the urethra has reduced calibre due to scarring of the urethral epithelium of the ureter that obstructs the urethral lumen. This narrowing often involves the spongy tissue adjacent to the epithelium, leading to the term “spongiofibrosis”.

The urethra is divided anatomically into two parts: anterior urethra (bulbar urethra and penile urethra) and posterior urethra (prostatic urethra and membranous urethra).

Treatment for Urethral Strictures

In general, urethral dilation, internal urethrotomy or urethroplasty can be used. The aim of the treatment, regardless of the technique used, is to re-establish the urethra’s normal calibre.

Urethral Dilation

This technique is intended to create a break in the scarred fibre without producing more inflammation and fibrosis.

Internal Urethrotomy

This is an endoscopic transurethral surgical procedure performed with a camera to directly view the stricture. Although the long-term success rate is low, it is the most commonly used primary technique, as it is less aggressive, faster and does not involve very invasive surgery.

Urethroplasty

Reconstructive surgery of the urethra is considered curative. It uses tissue transfer techniques (grafting or patching) to increase the urethral calibre.

What is Erectile Dysfunction?

Erectile dysfunction, commonly known as impotence, is the persistent inability to achieve and/or maintain an erection for satisfactory sexual performance.

It affects over 152 million men around the world and is more prevalent in men aged between 50 and 80. It is estimated to affect more than 10% of Portuguese men, i.e., around 450,000 people.

Erectile dysfunction is reflected in physical and psychosocial health and is a key cause of lower quality of life.

Treatment of Erectile Dysfunction

Treatment for erectile dysfunction, like the treatment for diseases such as diabetes, high blood pressure or cholesterol, generally implies a chronic condition. Only in some very specific situations is it transitory and can be considered curative.

The treatment includes:

  • Psychotherapy for psychogenic erectile dysfunction;
  •  Medication (orally administered pills) of phosphodiesterase type 5 inhibitors (avanafil, tadalafil, vardenafil and sildenafil);
  • Creams applied to the penis (alprostadil topical cream);
  • Injections of this drug into the penis (intracavernous alprostadil);
  • Penile prosthesis;
  • Penile revascularisation surgery (rarely used today);
  • Other (like the use of vacuum devices or a penile constriction ring);
  • Hormone replacement therapy for erectile dysfunction due to hormonal issues. 

Adopting a healthy lifestyle and healthy diet, losing weight, doing physical exercise and being less sedentary, quitting smoking, and controlling glycaemia and cholesterol levels (i.e., controlling diabetes and dyslipidemias in patients suffering from these diseases) are associated with improving endothelial function and a significant reduction in the systemic markers for vascular inflammation with a consequent improvement in erectile dysfunction.

 

What is Peyronie’s disease?

Peyronie’s disease is characterised by the curvature of the erect penis due to the presence of an abnormal fibrous plaque in the corpus cavernosum leading to a loss of elasticity. The fibrosis develops in the “sheath” of the tissue surrounding the corpus cavernosum – tunica albuginea – and its consequence is the development of a curvature that is only noticed when the penis is erect and which in general gradually worsens at the start of the disease. This curvature becomes more pronounced until it finally stabilises (and the angle of the curvature stops increasing).

This disease is named after the doctor François de La Peyronie who described it for the first time in 1743.

Treatment for Peyronie’s Disease

No effective medical therapy for this disease currently exists. However, medical therapy is used during the acute stage when the fibrous plaque is growing, i.e., in the 6–12 months at the start of the disease when the scarring is not yet complete.

The most effective treatment is surgical correction. This is advised in cases of significant and stable curvature when the angle is generally above 30 degrees or when accompanied by erectile dysfunction. It should only be performed when the curvature has been stabilised for at least 4–6 months.

The types of surgery (called corporoplasty) are the following:

  • Tunica albuginea plication;
  • Plaque incision;
  • Incision with grafting;
  • Excision with grafting;
  • Any of these methods associated with a penile prosthesis.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

  • Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
  • Specialist in Urology
  • Fellow of the European Board of Urology
  • Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
Referências

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