Urethroplasty at Institute of Urology Jaipur – A Case Report: Urethral strictures are a significant cause of lower urinary tract symptoms (LUTS) in men, often masquerading as benign prostatic hyperplasia (BPH) or other urological conditions. This case highlights the importance of thorough clinical evaluation and diagnostic imaging in identifying the underlying cause of obstructive urinary symptoms.
Case Presentation
A 56-year-old male presented to the Institute of Urology, Jaipur, with complaints of obstructive urinary symptoms, including decreased urine flow and nocturia, persisting for the past few weeks. The patient had undergone transurethral resection of the prostate (TURP) two years prior, with a residual mildly enlarged prostate on follow-up. Given the history of TURP, initial suspicion was of persistent bladder outlet obstruction due to residual prostatic enlargement.
Clinical Examination and Investigations
On physical examination, the patient exhibited no significant abnormal findings.
Laboratory and Imaging Studies
- Serum Creatinine: Normal, ruling out renal impairment.
- Ultrasound (USG): Mild prostatomegaly with bladder wall thickening, raising the possibility of bladder outlet obstruction.
- Retrograde Urethrogram (RGU): Crucial in establishing the definitive diagnosis, revealing a mid-penile urethral stricture as the primary cause of the patient’s obstructive symptoms.
Clinical Decision-Making and Treatment Plan
Given the findings, the patient and his family were counseled regarding the underlying pathology and the available treatment options. Considering the severity of the stricture and the likelihood of recurrence with endoscopic management, a decision was made to proceed with end-to-end urethroplasty as the definitive treatment.
Surgical Procedure and Outcome
Following standard preoperative evaluations, including physical and cardiac assessments, the patient was optimized for surgery. The end-to-end urethroplasty was successfully performed at the Institute of Urology, Jaipur. The procedure was well tolerated, and the patient had an uneventful recovery. He was discharged with appropriate post-operative care instructions.
Follow-Up and Outcome
Upon follow-up after a few weeks, the patient reported complete relief from urinary symptoms. Postoperative uroflowmetry revealed excellent urinary flow rates, confirming the success of the procedure.
Discussion and Take-Home Message
This case underscores the importance of clinical judgment in urology. While many patients with LUTS, particularly those with a history of TURP, may be presumed to have persistent prostate-related obstruction, further evaluation with RGU can reveal an alternative pathology such as a urethral stricture.
At the Institute of Urology, Jaipur, under the expertise of Dr. M. Roychowdhury and Dr. Rajan Bansal, an individualized approach is taken to every patient. Advanced diagnostic tools and clinical acumen ensure that the precise cause of symptoms is identified, leading to targeted and effective treatment. Our hospital provides comprehensive urological care, including consultations, investigations, imaging, and state-of-the-art surgical interventions, ensuring optimal patient outcomes.
Conclusion
This case highlights that urethral strictures can mimic symptoms of other urological conditions and emphasizes the role of detailed clinical assessment and appropriate imaging in reaching a correct diagnosis. Urethroplasty remains a gold-standard treatment, offering excellent long-term outcomes and symptom relief.
