๐ผ๐๐๐๐๐๐๐ ๐บ๐๐๐๐๐๐๐๐ Flashcards
What is urethral stricture?
An abnormal narrowing of any part of the urethra usually due to fibrosis resulting in loss of distensibility
What is the anatomical definition of the urethra?
A tubular structure extending from the bladder neck to the external urethral meatus present at the tip of the glans penis
What are the normal measurements of the urethra in males and females?
Males: 19-20cm; Females: 3-5cm
How is the urethra anatomically divided?
It is divided into anterior and posterior urethra
What are the three parts of the anterior urethra?
The penile part, the bulbar part, and the glandular part
What are the two components of the posterior urethra?
The prostatic urethra and membranous urethra, which is the narrowest & less distensible part
What characterizes the internal urethral sphincter?
Consists of smooth muscles innervated by nerves T12-L2 and are involuntary in nature
What characterizes the external urethral sphincter?
Consists of striated muscles innervated by S2-S4 and voluntary by nature
What is the main gonococcal cause of urethral stricture?
N. gonorrhea infection
Which patient population is commonly affected by gonococcal causes?
Sexually active patients with multiple sexual partners
What are the traumatic causes of urethral stricture?
Seen in straddle injury
Pelvic fracture
Passing of kidney stone
What are the iatrogenic causes of urethral stricture?
Traumatic urinary catheterization
Hypospadias repair
Unskilled circumcision
What is the pathogenic progression of N. gonorrhea infection in urethral stricture?
Germ attaches to pili to columnar epithelial cells โ Produces marked polymorphonuclear response โ Leucocyte exudates fill anterior urethra โ Inflammatory process extends to posterior urethra โ Granular tissue forms in mucosa & submucosa โ Eventual fibrosis & scarring โ Urethral stricture
What is the typical timeline for stricture formation following urethritis?
Takes an average of 10 years for symptoms to develop
How quickly do traumatic strictures present with symptoms?
Present with symptoms in 2 months
What are the main clinical presentations of urethral stricture?
โPlease Stop Dripping, Stop Being A Urinator!โ
โข Please โ Poor urination
โข Stop โ Slow urine stream
โข Dripping โ Decreased urine output
โข Stop โ Spraying of urine stream
โข Being โ Blood in urine
โข A โ Abdominal pain
โข Urinator โ Urethral discharge
What specific issues are commonly seen in men with urethral stricture?
UTI
Infertility
What are the characteristics of symptoms in urethral stricture?
Symptoms are usually insidious in onset and typically present as lower urinary system (LUS) symptoms
What are the key lower urinary system symptoms of urethral stricture?
Poor stream, spraying of urine, frequency, hesitancy, dribbling, acute & chronic retention
What are the main investigations for urethral stricture?
Urinalysis/urine microscopy & culture, blood urea & serum creatinine, ultrasound KUB, ultrasound of urethra, X-ray pelvis, retrograde urethrogram, antegrade cystourethrogram, cystourethroscopy
What is urethral dilation?
A treatment method involving enlarging the stricture by gradual stretching
What is the definition of urethrotomy?
Cutting the stricture with an endoscopic equipment
What is urethroplasty?
Surgical repair of the stricture with reconnection & reconstruction
What is the highest possible score in the urethral score system?
9
What are the three main categories assessed in urethral stricture scoring?
Urethral location, stricture length, and etiology
What is the length range for Score 2 strictures?
2-4cm
What are the three types of etiology in the scoring system?
Iatrogenic, inflammatory, and traumatic
What is the LSE system used for?
Assesses the severity & risk of recurrence based on length, segment & etiology
What are the indications for urethroplasty?
Failed conservative management, very long strictures, complicated strictures with periurethral abscess/calculi/neoplasia
