Different pathologies can cause mass effect in the urethra such as: hemangioma,
prolapse of the mucous membrane, condyloma, polyps, periurethral cyst, adenoma, epithelial
polyp and carcinomas8.
These pathologies can cause obstructive symptoms, sometimes of intermittent
characteristics, such as local pain, urethrorrhagia and hematuria8. The most common
urethral lesion in women is the caruncle, in most cases it can make a protrusion through
the meatus urinarius and this can cause obstructive symptoms8 (Fig.2). The estrogenic deficiency could be a possible
cause for this pathology, which occurs in menopause, the treatment in symptomatic cases
would be local estrogen therapy and anti-inflammatory and exceptionally surgical excision 9
. Among benign tumors of the urethra we observe leiomyomae, the hemangiomae and the
It is believed that the fibroepitheliomas are resulting from chronic urethral irritation
caused by undwelling mainly in paraplegic patient. The treatment in most cases is surgical
exeresis, which may lead to secondary urethral stenosis8.
Primary carcinomas of the feminine urethra are rare, they can be treated with radiotherapy
or surgical exeresis depending on histological type11. Garden11 noticed 40% of urethral stenosis after
treatment with radiotherapy for a urethra scaly tumor.
SURGICAL POST TREATMENT
The most frequent cause of urethral stenosis and iatrogenic (Fig.3), resulting from surgical treatment of the genital
prolapse or Urinary Incontinence, due to surgical hypercorrection12. In Marshall-
Marchetti-Krantzs surgery, urinary retention occurs in 5 to 20% of the cases7, 5 to 7%
in urethropexy by needle13
and 2.8 to 25% in slings or retropubic urethropexy14,15. In spite of the better understanding of the
physiopathology of urinary incontinence that allowed that the slings be done with no
tension, diminishing considerably the cases of obstruction, these procedures are the ones
that cause a larger degree of obstruction14. In these cases some authors preconize
urethrolysis and the operation of Urinary Incontinence14.
The urethras epithellum transforms itself due to estrogenic privation in
menopause, causing the transformation of the epithellum from squamous to columnar, which
characterizes senile urethritis16.
In the vulvar dystrophy a urethral mucosa atrophy occurs due to a low hormonal level,
causing a dryness of the urethra and then hypovascularization, leaving this sensitive to
infections and traumas, which may cause a stenosis, generally meatus stenosis12 (Fig. 4), which treatment consist of hormonal reposition,
urethral dilation or even meatotomy.
An obstruction at the level of the vesicle bladder may occur due to the inadequate
opening of such, in Marions illness17. In these cases the urodynamic study
reveals a detrusor pressure (Pdet) larger that 60 cm H 2O with
corresponding maximum urinary flux lower that 15 ml/s17.
More rarely may occur a functional obstruction of the urethra due to hypertonia of the
external urethral sphincter, in these cases an elevated pressure of the detrusor is
noticed and a low maximum urinary flux, the urethral calibration is normal (22Fr)18. Noble19 in 1995 measured
the thickness of the striated sphincter using transvaginal ultrasound in women with an
obstruction, with the video urodynamic, in comparison with women with no obstruction, it
was observed that in average the volume of the obstructed patients sphincter was of
3cm3 against 1.3cm3 but not obstructed. Meanwhile the
author questions if this factor could be considered as a cause of obstruction in these
selected cases where the patients have a competent bladder necks an internal urethrotomy
is indicated, to avoid post treatment Urinary Incontinence18. In women submitted to internal
urethrotomy a depression occurs in the maximum urethral profile, but with no alteration in
pressure transmission, showing in these cases a lesion in the intrinsic mechanism of the
urethral coaptation, not affecting the extrinsic mechanism of urinary incontinence20.