The Effective treatment of Urethral stricture with Homeopathy

- Article by Dr Sunitha Devi Vannemreddy M.D(Hom)
 drsunithavannemreddy@gmail.com

Urethra is the opening that allows the urine to leave the bladder. Urethra has a sphincter mechanism that holds urine inside the bladder. When urine fills in the bladder, there is both voluntary and involuntary control to open the urethra to allow the urine to come out. In men, it is thin tube like structure that starts from lower opening of the bladder, traverses entire length of penis. In women, it is a short opening coming off lower opening of bladder and between 2.5 to 4 cms length.

You might also interested:
. Cases  . children  . Clinical  . Drdevendra .HomeopathicTherapeutics .Homeopathy .General .Homeopathy .Products .Materia medica .Pharmacy .Philosophy  .Repertory .Research .Therapeutics .Treatment .Women

Urethral stricture refers to narrowing of urethra for any other reason, whether or not it actually impacts the flow of urine out of the bladder. Urethral stricture caused by injury, instrumentation, infection and some non inflammatory causes of urethritis or by formation of scar tissue. Scar tissue can be result of many factors. 

Causes of urethral stricture:

It can be caused by many factors. It is mostly affected to males than females. Young boys who has hypospadias surgery (procedure to correct the underdeveloped urethra). And men who has penile implants have higher chance of getting urethral stricture.

A straddle injury is the common type of cause for urethral stricture. Examples of straddle injury are getting hit from cycle bar, falling and affecting on scrotum. Other specific causes including pelvic fracture, catheter insertion, radiation and surgery performed on prostate.

Urethral stricture after blunt trauma can be divided into,

•           Pelvic fracture associated urethral disruption occurs in severe pelvic fracture.
•           Blunt trauma to perineum compresses the bulbar urethra against pubic symphysis, causing a crush injury.

Tumors located in close proximity of urethra, untreated urinary tract infection, lichen sclerosis and sexually transmitted diseases like gonorrhoea also causes urethral stricture.

Surgery to address hypospadias can result in delayed urethral stricture, even decades after original surgery. 

Signs and symptoms:

·          Hallmark sign of urethral stricture is weak urinary stream.

·         Splaying of urinary stream

·         Urinary frequency

·         Urinary urgency

·         Straining for urination.

·         Pain during urination

·         Urinary tract infection

·         Prostatitis

·         Inability to empty the bladder

·         Urinary retention

·         Urinary incontinence

·         Blood in urine (hematuria)

·         Semen in urine (semenuria)

·         Discharge from urethra

·         Reduced ejaculation force

·         Penile swelling

Risk factors of urethral stricture:

·         Mostly men are at risk compared to women.

·         Who have had one or more STI’s (sexually transmitted infections)

·         Who have used a catheter

·         Who have urethritis

·         Who have prostate enlargement.

Complications:

·         Urinary retention

·         Prostatitis

·         Bladder dysfunction

·         Urinary diverticulum

·         Periurethral abscess

·         Fournier’s gangrene

·         Urethral fistula

·         Bilateral hydronephrosis

·         Urinary infection

·         Urinary calculus

Diagnosis:

To diagnose the urethral stricture,

·         Reviewing the complaints, medical history and past illnesses.

·         Performance of physical examination. Observing the penis for redness, hardness and swelling.

·         Tests like,

Ø  measuring the rate of flow during urination (urine analsis)

Ø  analysing the physical and chemical properties of urine (urine culture)

Ø  cytoscopy

Ø  Measuring the size of urethral opening and tests for clamydia, gonorrhoea(urethral culture).

Ø  Examination of prostate and screening for prostate cancer and measurement of prostate specific antigen (PSA)

Ø  Imaging and endoscopic studies are necessary to confirm the diagnosis and identifying the cause of urethral stricture.

·         Common imaging and endoscopic tests are,

Ø  Ultrasound of urethra

Ø  Retrograde urethrogram

Ø  Anterograde cystourethrogram

Ø  Cystourethroscopy

Treatment:

Main aim for urethral stricture treatment is, to improve the flow of urination, betterment of complaints like pain, redness, swelling and dribbling of urination and avoiding the possible complications of urethral stricture.

Treatments available in Allopathy:

·         Urethral dilatation - widening of stricture. This procedure will be done under general anaesthesia and involves passing thin metal rod into urethra. Slowly widens the stricture until no scarring.

     With this procedure, flow of urine improves; emptying bladder will reduce the urinary tract infection.

     But with this procedure, pain while passing urination, bleeding, passing urine more often are the complications. Recurrence of stricture may often occur.

·         Optical Urethrotomy – internal cutting along stricture. This procedure will be done under general anaesthesia and it is a simple surgery using the special telescopic electric knife to remove the part of stricture which is blocking the flow. Complete stricture cannot be removed with this procedure.

          With this procedure, flow of urine improved, emptying of bladder will reduce possible infections.

          After this surgery person can be recovered and back to normal life within two weeks.               Possible complications with this procedure are pain while passing urine, hematuria, infections and recurrence of stricture.

·         Urethroplasty – open repair of stricture. It is a surgical repair of urethra. Depending on length and location of urethral stricture, options available are,

Ø  Excision of stricture and reconnection of healthy urethra

Ø  Excision of stricture and reconnection with graft

Ø  Graft reconstruction alone.

                Recovery rates are better. Flow of urine and discomfort while passing urination improved and urinary tract infections are reduced. Person can go back to normal life after four weeks of surgery.

              Possible complications with this surgery includes,

Ø  Bleeding, infections

Ø  Injury to adjacent organs and structures and their functions

Ø  Chronic pain

Ø  Possible changes in sexual functions, like, poor erection, penile curvature and changes in ejactulation may occur.

·         Holmium laser endourethrotomy – It is laser operation of urethral stricture, which doesn’t require much time and less possibility of infection. In this technique, person need not to stay too long in hospital and simple procedure to remove the stricture urethra with laser.

Advantages are:

Ø  Less post operative pain.

Ø  Less bleeding

Ø  Less post operative infection.

Ø  Recovery is faster than normal surgical procedure.

Ø  Urine flow improves.

Complications are lesser than other procedures but chances of recurrence of stricture are one of the complications. 

Urethral stricture treatment with Ayruveda:

Ayurveda is mainly based on ingredients of medicinal plants. For urethral stricture treatment, they use both oral and local applicants. They claim that prescribed use of oral medication like kashyam and powders along with milk and medicinal application of oils to urethra will relieve the complaints.

They claim that, with ayurvedic medication, patients complaints like, flow of urine improves, pain and swelling and other associated complaints are completely relieved and recurrence of urethral stricture are very less.

Urethral stricture treatment with Homeopathy:

Homeopathy is constitutional and conventional treatment in which main aim is to relieve the complaints in mild, gentle and permanent way. Person to be treated mentally, emotionally and physically, as a whole, which improves the health and living style. In urethral stricture treatment, for allopathy there is no medical treatment instead of surgical interventions which leaves some complications. But in homeopathy there is wide range of medicines are there to prescribe, according to the totality of the complaints.

Advantages and aims of Homeopathic treatment are,

Ø  Flow of the urine improves

Ø  Associated complaints like pain, swelling relieved.

Ø  Urethral stricture due to injury or hurts is treated with root cause.

Ø  Urethral stricture due to urinary tract infections or gonorrhoea like STD’s are treated with homeopathic medications which relieves the stricture complaints.

Ø  Prostatic problems or other complaints which causes urethral stricture are treated with homeopathy which successfully relieves the complaints.

Ø  It eases the flow of urine, dribbling of urine and urine retention.

Ø  It acts on urinary muscles and membranes to avoid further progression and complications of complaints.

Ø  It will reduce or prolong the chances of recurrence of urethral stricture.

Ø  Homeopathy relieves the complaints after dilations and other surgical procedures.

Ø  Side effects of other conventional treatments or surgical procedures are treated with homeopathy without any side effects. 

Homeopathic rubrics for urethral strictures:

·         Urethra, stricture

·         Urethra, stricture, bruised pain in testes with

·         Urethra, stricture, convulsive, spasmodic

·         Urethra, constriction, convulsive, spasmodic

·         Urethra, constriction, urination during

·         Urethra, haemorrhages, gonorrhoea, after suppressed

·         Urethra, haemorrhages, urination, after

·         Urethra, inflammation, chronic

·         Urethra, narrowing of

·         Urethra, pain, drawing.

·         Urethra, pain, agonising

·         Urethra, pain, drawing, urination after

·         Urethra, pain, dragging, extending to bladder

·         Urethra, tumor

·         Urine, bloody

·         Bladder, urination, difficult

·         Bladder, urination, dribbling by drops

·         Bladder, urination, dribbling by drops, retention with

·         Bladder, urination, dysuria, stricture with

·         Bladder, urination, interrupted

·         Bladder, urination, unsatisfactory, bladder was not emptying, as if dribbling

·         Urethra, gonorrhoea, suppressed. 

Best remedies for urethral stricture:

cantharis, clematis, nitric acidum, petroleum, puls, apis, berberis, conium, indigo, kali iod, merc, petroselinum, sulph iod.

Cantharis: Retention of urine with cramp like pain in bladder. Urgent and ineffectual effort to urinate, with painful emission, drop by drop. Urination is difficult, weak and scattered. Urine is pale yellow or deep red coloured. Flow of sanguineous mucus from bladder. Emission of blood. Purulent urine. Burning and smarting on urination. Incisive pain in the front part of urethra during and after urination. Sharp, tearing, incisive pains, successive pulling and pulsations in the urinary organs. Burning, stinging and tearing in kidneys. Pressing pain in the kidneys extending to bladder along ureters relieved by pressing upon glans. Exceedingly painful sensibility of the region of bladder on touching.

Clematis: Burning sensation and smarting in urethra, on commencing to urinate. Stitching sensation in urethra extending to abdomen. Contraction in urethra, with urine stopping suddenly or flowing drop by drop. Jerk like tearing pain in the front part of urethra during intervals. Purulent urine. Urine is turbid, milky with violent pain while passing last drops.

Nitric acidum: Frequent want to urinate, with scanty emission of deep coloured urine. Incontinence of urine. Painful emission of urine. Micturition in thin stream from stricture.  Urine is cold when passed. Foetid, strong smelled urine like horse’s urine. Smarting and burning pain in urethra while passing urine. Swelling of orifice of urethra. Needle like stitches in orifice of urethra. Ulcers in urethra. Discharge of mucus sanguineous kind of.

Petroleum: Constant dribbling of urine after micturition. Discharge of mucus from urine. Frequent emission of urine with scanty flow. Urine is bloody or turbid with deposits of red slimy sand. Involuntary discharge of urine especially during night. Burning pain in urethra. Stricture urethra after chronic urethritis.

Pulsatilla: Contraction of urethra with small stream of urine. Burning pain during micturition. Burning during and after urination. Pulling and pressure in urethra extending to bladder. Contraction in urethra with soreness in that region. Swelling at urethra with soreness when touched, intermittent stream of urine with violent pain dragging to bladder. Urine is watery colourless, brown and bloody. Severe alternating pains which changes position frequently. Associated with great anxiety. Old cases of gonorrhoea.

Apis: Burning and soreness when urinating. Strangury. Pain in the urethra with soreness on pressure and while stooping.  Frequent desire for urination with passage of only few drops. Urine is scant and high coloured with thirstlessness. Incontinence of when coughing and other circumstances. Burning and stinging pain in urethra, as if scalded.  Bladder is very painful after tenesmus and after urination. Urine is dark, frothy and sediments like coffee grounds.  

Berberis: Incisive pains in urethra even not urinating. Smarting pain in urethra with sensation of excoriation, even during emission of semen during coition. Motion excites and aggravates pain in urethra. Burning pain in urethra during and after urination but more after urination. Stitching and shooting pains extending to loins and thighs.  Urine is pale yellow, slimy and gelatinous.

Conium: Incisive pain in urethra during urination. Burning and shooting pain urethra especially after urination. Viscid mucus mixed with blood, which cannot be passed without severe pain. Urine flow drop by drop stops suddenly and doesn’t begin to flow for some moment. Pressure in the bladder with violent stitching pain bladder which is more while walking and better by sitting.

Indigo: suitable remedy for stricture urethra. Violent contraction of urethra with pain in bladder. Painful emission of small quantities of turbid urine. Frequent desire to urinate with difficulty in urination associated with thirstlessness.

Mercuris: Affections of urethra with continued want of urination with scanty flow. Flow of urine is like drop by drop. Urine is deep coloured, turbid and offensive smell. Thick, hard sediments of mucus from urine. Discharge of blood from urethra.  Pulsating, shooting pains in urethra even not urinating. Thick greenish discharge from urethra from gonorrhoea.

Petroselinum: constant dribbling of urine after micturition. Discharge of mucus with urine. Frequent emission of urine with scanty, bloody and foetid flow of urine. Burning of urethra. Stricture urethra after chronic urethritis.  

Sulph iod: Itching in urethra. Frequent micturitions especially in the morning with scanty and painful flow of urine. Stricture urethra. Shooting pain in bladder extending to urethra. Urine is thick, whitish and creamy.

These are some of the indicated remedies which help in urethral stricture cases. But proper case taking and drawing the personality of the patient by taking totality of mental, emotional and physical symptoms of the patient, analysing and repertorising the symptoms will give a correct constitutional remedy which suits the person. With this classical homeopathy we can treat the cases of urethral stricture by relieving from complaints, improving the well being of the person and reducing the complications of the case. But at the same time we have to understand our scope and limitations with homeopathic system of medicine. This process will give us successful cases.