Male Urethral Stricture Flashcards
What is the mucosal histology of the posterior urethra, anterior urethra, and fossa navicularis?
posterior: transitional epithelium
anterior: pseudostratified columnar epithelium
fossa navicularis: stratified squamous epithelium
What are presenting features of urethral stricture?
decreased urinary stream
incomplete bladder emptying
UTI
epididymitis
rising PVR
decreased force of ejaculation
dysuria
spraying
What important factors are there to consider for positioning during urethral stricture repair?
high lithotomy
avoid pressure on calf muscles, peroneal nerve and ulnar nerve
use SCDs to prevent VTE
After a urethral repair, what follow up imaging is recommended?
urethrography or VCUG 2-3 weeks after
replace catheter if persistent leak to avoid inflammation, urinoma, abscess, and/or urethrocutaneous fistula
Clinicians SHOULD include urethral stricture in ddx of men who present with which symptoms?
GUIDELINE STATEMENT 1
decreased urinary stream
incomplete emptying
dysuria
UTI
rising PVR
*stricture characteristics (length, diameter, duration of obstruction) lend to sxs
Risk factors for forming urethral stricture?
hypospadias surgery
urethral catheterization or instrumentation
traumatic injury
transurethral surgery
prostate cancer
idiopathic
inflammatory disorder (LS)
What non invasive measures can be performed initially in a patient with suspected urethral stricture?
GUIDELINE STATEMENT 2
H&P
UA
Uroflow
PVR
*AUA-SS
What evaluations would be next step to confirm diagnosis of urethral stricture after non-invasive measures?
GUIDELINE STATEMENT 3
Cysto
RUG
VCUG
US urethrography
MRI (can provide detail in certain cases, e.g diverticulum, fistula, cancer)
In planning non-urgent intervention for known stricture what must be determined:
GUIDELINE STATEMENT 4
length and location
Patients with symptomatic stricture including urinary retention or need for catheterization, may undergo which procedures urgently?
GUIDELINES STATEMENT 5
DVIU
SPT
GUIDELINE STATEMENT 6
surgeons may place SPT prior to definitive urethroplasty depending on CIC Or foley
“urethral rest” 4-12 weeks
What is considered a short bulbar urethral stricture? What is an initial treatment options?
GUIDELINE STATEMENT 7
< 2 CM
DVIU or dilation
urethroplasty
What types of endoscopic treatment may be offered for urethral stricture? When may catheter be removed if uncomplicated procedure?
GUIDELINE STATEMENT 8
Dilation
DVIU
GUIDELINE STATEMENT 9
72 hours
For pts who are not candidates for urethroplasty, who have undergone DVIU, clinicians may recommend what at home activity?
GUIDELINE STATEMENT 10
self-catheterization to maintain temporary urethral patency
ranging daily to weekly > 4 mo reduces recurrence
For recurrent anterior urethral strictures, after failed dilation/DVIU, what management is recommended?
GUIDELINE STATEMENT 11
Urethroplasty
For surgeons who do not perform urethroplasty, what is an option?
GUIDELINE STATEMENT 12
refer to surgeon with expertise
Initial treatment of metal or fossa navicularis strictures?
GUIDELINE STATEMENT 13
dilation or meatotomy
as long as not associated with previous hypo repair, prior failed endoscopic treatment, previous urethroplasty, or LS
Recurrent metal or fossa navicularis strictures, should be treated with?
GUIDELINE STATEMENT 14
urethroplasty
*or associated with hypospadias or LS