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11. Trauma y Reconstruccion (1018) > Urethral Stricture > Flashcards

Urethral Stricture Flashcards

1
Q

What is the lining of the posterior urethra?

A

Transitional epithelium

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2
Q

What is the lining of the anterior urethra?

A

pseudostratified squamous epithelium

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3
Q

What is the lining of the fossa navicularis?

A

stratified squamous epithelium

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4
Q

What is narrowing of the posterior urethra called?

A

stenosis

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5
Q

What is narrowing of the anterior urethra called?

A

stricture

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6
Q

What are the two leading causes of urethral strictures in developed countries?

A

Idiopathic 41%

Iatrogenic 35%

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7
Q

What is the leading cause of urethral stricture in developing countries?

A

Trauma 36%

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8
Q

What are the common presenting symptoms of patients with urethral strictures?

A 
Decreased urine stream
Incomplete emptying 
UTI
Epididymitis
Decreased ejaculation
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9
Q

What should be included in the workup of a patient with slow stream?

A 
Thorough history
Physical exam
UA
Urine culture
PVR
Uroflow/UDS
Cystoscopy
RUG
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10
Q

What is the duration of foley catheter placement following surgery for urethral structure?

A

Typically 2-3 weeks after which a RUG or VCUG is obtained.

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11
Q

What are the possible sexual side effects of urethroplasty?

A

Ejaculatory dysfunction 21%

Erectile dysfunction 1%

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12
Q

What is the uroflow rate associated with urethral strictures?

A

Less than 12ml/s

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13
Q

What is recommended to confirm the diagnosis of a urethral stricture?

A

Urethroscopy
RUG
VCUG
US urethography

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14
Q

What is the diagnostic of choice for confirmation of urethral stricture?

A

RUG

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15
Q

What information is required before planning treatment for a stricture?

A

Length and location of the stricture.

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16
Q

What are the treatment options when a patient is in urinary retention and has a urethral stricture?

A

Suprapubic cystostomy
Urethral dilation
DVIU

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17
Q

What should be done before definitive management for a urethral stricture if urethroplasty is being considered?

A

4-12 weeks of urethral rest with suprapubic tube if necessary to allow full stricture to declare itself.

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18
Q

What are the treatment options and success rates for bulbar urethral strictures < 2cm?

A

Dilation (35-70%)
DVIU (35-70%)
Urethroplasty (80-95%)

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19
Q

How does DVIU compare to dilation when endoscopic management is desired?

A

Dilation and DVIU may be used interchangeably

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20
Q

What is the data regarding injection of steroids or mitomycin C at time of stricture treatment?

A

There is weak evidence to suggest that it decreases recurrence rate but stronger studies with long term follow up are needed.

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21
Q

When can catheters be removed safely following DVIU or dilation?

A

24-72 hours

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22
Q

What is the next step in a patient who just underwent a redo DVIU but is not a candidate for a urethroplasty?

A

They should be started on self catheterization as stricture recurrence rates were significantly lower among patients performing self-catheterization (risk ratio 0.51, 95% CI 0.32 to 0.81, p = 0.004

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23
Q

What is the next step in most patients who failed at least one endoscopic procedure for urethral stricture?

A

Urethroplasty

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24
Q

What is the failure rate for repeat endoscopic management of urethral strictures?

A

> 80%

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25
Q

What are the initial options for treatment of meatal or fossa navicularis strictures?

A

Dilation

Meatotomy

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26
Q

What factors may complicate tx of fossa navicularis/meatal strictures?

A

Hypospadias repair
Failed endoscopy
Urethroplasty
Lichen sclerosis

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27
Q

What initial tx can be used for meatal strictures due to LS?

A

extended meatotomy in conjunction with high-dose topical steroids

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28
Q

What should be done with the patient that has recurrent meatal or fossa navicularis strictures?

A

Surgeons should offer urethroplasty.

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29
Q

What is the success rate of uncomplicated meatotomy?

A

87%

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30
Q

What is the most common method of repair for the fossa navicularis?

A

Penile fasciocutaneous flap

Oral mucosa graft

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31
Q

What is the success rate of penile fasciocutaneous grafts?

A

94%

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32
Q

What is the success rate of oral mucosal grafts?

A

83-100%

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33
Q

What is the recommended treatment option for penile urethral strictures?

A

Urethroplasty

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34
Q

A patient has a bulbar urethral stricture >2cm. What is the preferred treatment?

A

Urethroplasty

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35
Q

A patient has Bulbar urethral stricture >4cm. How do the success rates between endoscopic tx and urethroplasty compare for these types of strictures?

A

Endoscopic: 20%
Urethroplasty: >80%

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36
Q

What is the first choice graft harvest site for urethroplasty?

A

The inner cheek

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37
Q

What is the problem with performing a single stage tubularized graft?

A

High rate of restenosis

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38
Q

What are the tx options for bladder neck contracture after endoscopic prostate procedure or vesicourethral anastomoses?

A

Dilation
bladder neck incision
TURBN

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39
Q

What is the success rate for first time tx of vesicourethral anastomotic strictures?

A

50-80%

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40
Q

What are the treatment options for patients on CIC for neurogenic bladder who develop a stricture?

A

Urethroplasty

Suprapubic tube

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41
Q

What should be done if lichen sclerosis is suspected?

A

Biopsy

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42
Q

What is the rate of squamous cell carcinoma in patients with lichen sclerosis?

A

2-8.6%

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43
Q

How should lichen sclerosis be treated?

A

Clobetasol

mometasone

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44
Q

What should be avoided when treating lichen sclerosis?

A

Avoid genital skin flaps

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45
Q

What should be done to evaluate the urethra in fracture urethral injuries?

A

retrograde urethrography, voiding cystourethrography (VCUG) and/or retrograde urethroscopy

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46
Q

A patient has a pelvic fracture urethral injury. What treatment is recommended

A

Delayed urethroplasty

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47
Q

What are the methods of gaining urethral length during an anastomotic urethroplasty?

A
  1. Mobilize the bulbar urethra
  2. Crural separation
  3. Inferior pubectomy and supracrural rerouting
  4. Transabdominal, transpubic.
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48
Q

What is the standard amount of time to wait after a pelvic fracture urethral injury before urethroplasty?

A

3-6 months.

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49
Q

What is the mucosal histology of the posterior urethra, anterior urethra, and fossa navicularis?

A

posterior: transitional epithelium
anterior: pseudostratified columnar epithelium

fossa navicularis: stratified squamous epithelium

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50
Q

What are presenting features of urethral stricture?

A

decreased urinary stream
incomplete bladder emptying
UTI
epididymitis
rising PVR
decreased force of ejaculation
dysuria
spraying

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51
Q

What important factors are there to consider for positioning during urethral stricture repair?

A

high lithotomy
avoid pressure on calf muscles, peroneal nerve and ulnar nerve
use SCDs to prevent VTE

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52
Q

After a urethral repair, what follow up imaging is recommended?

A

urethrography or VCUG 2-3 weeks after
replace catheter if persistent leak to avoid inflammation, urinoma, abscess, and/or urethrocutaneous fistula

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53
Q

Clinicians SHOULD include urethral stricture in ddx of men who present with which symptoms?

A

GUIDELINE STATEMENT 1

decreased urinary stream
incomplete emptying
dysuria
UTI
rising PVR

*stricture characteristics (length, diameter, duration of obstruction) lend to sxs

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54
Q

Risk factors for forming urethral stricture?

A

hypospadias surgery
urethral catheterization or instrumentation
traumatic injury
transurethral surgery
prostate cancer
idiopathic
inflammatory disorder (LS)

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55
Q

What non invasive measures can be performed initially in a patient with suspected urethral stricture?

A

GUIDELINE STATEMENT 2

H&P
UA
Uroflow
PVR

*AUA-SS

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56
Q

What evaluations would be next step to confirm diagnosis of urethral stricture after non-invasive measures?

A

GUIDELINE STATEMENT 3

Cysto
RUG
VCUG
US urethrography
MRI (can provide detail in certain cases, e.g diverticulum, fistula, cancer)

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57
Q

In planning non-urgent intervention for known stricture what must be determined:

A

GUIDELINE STATEMENT 4

length and location

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58
Q

Patients with symptomatic stricture including urinary retention or need for catheterization, may undergo which procedures urgently?

A

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

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59
Q

What is considered a short bulbar urethral stricture? What is an initial treatment options?

A

GUIDELINE STATEMENT 7

< 2 CM

DVIU or dilation

urethroplasty

60
Q

What types of endoscopic treatment may be offered for urethral stricture? When may catheter be removed if uncomplicated procedure?

A

GUIDELINE STATEMENT 8

Dilation

DVIU

GUIDELINE STATEMENT 9

72 hours

61
Q

For pts who are not candidates for urethroplasty, who have undergone DVIU, clinicians may recommend what at home activity?

A

GUIDELINE STATEMENT 10

self-catheterization to maintain temporary urethral patency

ranging daily to weekly > 4 mo reduces recurrence

62
Q

For recurrent anterior urethral strictures, after failed dilation/DVIU, what management is recommended?

A

GUIDELINE STATEMENT 11

Urethroplasty

63
Q

For surgeons who do not perform urethroplasty, what is an option?

A

GUIDELINE STATEMENT 12

refer to surgeon with expertise

64
Q

Initial treatment of metal or fossa navicularis strictures?

A

GUIDELINE STATEMENT 13

dilation or meatotomy

as long as not associated with previous hypo repair, prior failed endoscopic treatment, previous urethroplasty, or LS

65
Q

Recurrent metal or fossa navicularis strictures, should be treated with?

A

GUIDELINE STATEMENT 14

urethroplasty

*or associated with hypospadias or LS

66
Q

Penile urethral strictures should be treated with?

A

GUIDELINE STATEMENT 15

urethroplasty due to high recurrence rates with endoscopic tx

67
Q

Patient with bulbar strictures > 2 cm should be treated with?

A

GUIDELINE STATEMENT 16

urethroplasty due to low success rate of DVIU/dilation

68
Q

Multi-segment strictures may be reconstructed utilizing what surgical technique and material?

A

GUIDELINE STATEMENT 17

One stage or multistage

oral mucosal graft, penile fasciocutaneous flap or combo

69
Q

what is a long term alternative for severe complex or length strictures?

A

GUIDELINE STATEMET 18

perineal urethrostomy

*recurrent complex anterior stricture, advanced age, medical co-morbidities, extensive LS, numerous failed urethroplasty, and patient choice

70
Q

What is the first choice when using grafts for urethroplasty? What materials/donor sites shouldn’t be used?

A

GUIDELINE STATEMENT 19

oral mucosa

*inner cheek, be careful of salivary gland

GUIDELINE STATEMENT 20

should not perform substitution urethroplasty with allograft, xenograft, or synthetic materials

GUIDELINE STATEMETN 22

do not use hair-bearing skin

71
Q

What technique should not be performed by a single-stage?

A

GUIDELINE STATEMENT 21

tubularized graft urethroplasty

due to high risk of restenosis

72
Q

After pelvic fracture urethral injury (PFUI), planning a delayed repair, what testing should be done pre-operaitvely?

A

GUIDELINE STATEMENT 23

RUG + VCUG

and/or

Retrograde + Antegrade Cystoscopy

Other adjunctive tests include: pelvic CT or MRI to assess proximal extent of injury

73
Q

After PFUI with urethral obstruction/obliteration due to pelvic fracture, what type of repair should be done? When?

A

GUIDELINE STATEMENT 24

delayed urethroplasty

GUIDELINE STATMENT 25

only after major injuries have stabilized and patients can be safely positioned

74
Q

What are treatment options for bladder neck contracture after endoscopic prostate procedure?

A

GUIDELINE STATEMENT 26

Dilation

Bladder neck incision

transurethral resection of bladder neck contracture

75
Q

What are treatment options for bladder neck contracture post prostatectomy for vesicourethral anastomotic strictures? What is performed for recalcitrant stenosis?

A

GUIDELINE STATEMENT 27

dilation

vesicourethral incision

transurethral resection

*lower success in cases of radiation

GUIDELINE STATEMENT 28

open reconstruction of bladder neck

*may need sphincter

76
Q

Men who perform chronic CIC with strictures may be offered which treatment?

A

GUIDELINE STATMENT 29

urethroplasty

when causing problems with CIC

77
Q

If alternative pathology is suspected in the urethra?

A

GUIDELINE STATEMENT 30

biopsy

for LS or suspected urethral cancer

78
Q

Urethroplasty in a patient with LS, what is important to remember?

A

GUIDELINE STATEMENT 31

do not use genital skin

79
Q

Follow up of urethral strictures?

A

GUIDELINE STATEMENT 32

monitor for symptomatic recurrence following dilation, DVIU, and urethroplasty

utilize AUA SS, uroflow, pvr

*can occur at any time

*risks for recurrence failed tx, tobacco, DM, increasing length, LS, hypo. graft/flap

80
Q

AUA SS includes which elements, plus bother:

A
81
Q

In the setting of a prior urethral stricture dilation, with pelvic trauma/fracture and blood at the meatus, what is the significance of a butterfly hematoma?

A

urethral injury

contained in Colles’ facia

superiorly the extravasation can extend to clavicles where Scarpa’s facies the abdominal extension of Colles’ facia attaches

82
Q

Describe endoscopic realignment in patient with urethral disruption for whom you have placed a SPT:

A

2 surgeons

flexible/rigid cystoscopy via urethra and SPT to try to pass a wire across the defect with fluoroscopy

prolonged attempts should not be performed

83
Q

Describe posterior urethral stricture repair?

A
  1. high lithotomy
  2. lamba incision in perineum
  3. divde bulbospongiosus muscle
  4. circumferentially mobilize urethra distally to penoscrotal junction and proximally to obliterated segment of the urethra
  5. excise intervening scar between distal urethral segment and apex of prostate
  6. identify prostatic apex, if cannot reach → separate corpus cavernosum in midline, if cannot reach → perform pubectomy (give additional length), if still cannot reach → re-route urethra under ones side of corpus cavernosum
  7. Tension free anastomosis
  8. Foley
84
Q

Etiologies of low Qmax and elevated PVR in a male?

A

NGB

BPH

urethral stricture

85
Q

List risks of urethroplasty:

A

bleeding
infection
DVT
nerve damage (peroneal)
rectal injury
testicular injury
stricture recurrence
ED
EjD
urethrocutaneous fistula formation
penile chordee
altered penile sensation
post void dribbling
mouth scarring (buccal)
obstruction of salivary duct (buccal)

86
Q

Describe a bulbar EPA urethroplasty:

A
  1. vertical midline perineal incision
  2. dissect through Colles’ facia
  3. divide bulbospongiosus muscle
  4. circumferentially mobilize the urethral distally to penoscrotal junction and proximally towards membranous urethra after dividing central tenon
  5. ID stricture by cysto
  6. excise urethral stricture
  7. spatulate proximal and distal ends of urethral 1 cm on each side
  8. Distal spatulate ventrally
  9. proximal spatulate dorsally
  10. anastomosis with absorbable interrupted
  11. foley
  12. close
87
Q

Describe substitution urethroplasty with buccal mucosa:

A
  1. vertical midline perineal incision
  2. dissect Colles’ facia
  3. sharply divide bulbospongiosus muscle
  4. ID stricture via cysto
  5. excise urethral stricture
  6. spatulate urethra dorsally 1 cm on each side, measure defect
  7. harvest buccal mucosa
  8. fenestrate for dorsal, don’t fenestrate for ventral
  9. lay graft on corporal bodies an secure with absorbable suture
  10. close lateral sides of buccal graft to native urethra with absorbable suture
  11. test anastomosis for water tightness with irrigation in urethra
  12. foley
  13. close
88
Q

What is blood supply to penis?

A

Internal iliac artery

Internal pudendal artery

Common penile artery
Bulbourethral artery → corpus spongiosum
Dorsal artery of penis → glans
Cavernosal artery → corpus cavernosa
Circumflex artery → crus of corpus cavernosa

89
Q

What is blood supply to urethra?

A

dual blood supply

Proximal: bulbourethral artery → proximal corpus spongiosum

Distal: dorsal artery of penis → via communicators to glans penis

90
Q

What questions do you ask a patient with suspect urethral stricture?

A

History of perineal/scrotal trauma

prior UTIs/STIs

Sexually active, ED, EjD

length of time of sxs

episodes of retention

hx of catheterization or difficulty with cath

hematuria

AUA SS

91
Q

What is recurrence rate of DVIU at one year?

A

50% in 1 year

Follow with AUA SS, uroflow/pvr, cysto, RUG

92
Q

At what diameter to strictures become symptomatic?

A

< 14 Fr

93
Q

How does the location of the urethra differ between the penile and bulbar urethra?

A

The urethra is more dorsal in the spongiosum in the bulbar urethra and more central in the penile urethra.

94
Q

What is the blood supply route to the deep penile structures?

A

Internal iliac –> Anterior division –> Internal pudendal –> Common Penile

95
Q

What are the 4 branches of the common penile artery?

A

Bulbar artery
Urethral artery
Cavernosal artery
Deep dorsal artery

96
Q

Recommend storage volume for orthotopic neobladder

A

400-500cc

97
Q

Urinary continence mechanism for orthotopic neobladders

A

rhabdosphincter

98
Q

Most definitive long term solution for uretero-enteric structures

A

surgical repair

must rule out malignancy

99
Q

Options for first time bulbar urethral strictures <2 cm

A

Dilation

DVIU

100
Q

Success rate of short bulbar strictures

A

50%

101
Q

Operative recommendation for short bulbar strictures < 2 cm

A

excision and primary anastomosis.

Longer strictures or any penile strictures require graft or flap.

102
Q

Stages of graft intake

A
  1. first 48 hours: imbibition–> graft receives nutrients through diffusion.
  2. Inosculation: Next 48 hours–> graft vessels connect with recipient bed vessels.
  3. neovascularization 4-6 days`
103
Q

Female urethral stricture

A
104
Q

What is the normal caliber of the female urethra?

A

22F (18F - 28F 95% CI)

105
Q

Name two types of flap urethroplasty techniques for female urethral reconstruction.

A

Blandy and Orandi techniques.

106
Q

What are the main categories of voiding dysfunction?

A

Detrusor underactivity (DU) and bladder outflow obstruction (BOO).

107
Q

What percentage of female urethral stricture cases are considered idiopathic?

A

44%-51% (Referenced from the etiology statistics)

108
Q

What are the key symptoms associated with Female Urethral Stricture (FUS)?

A

Slow flow, incomplete bladder emptying, urine spraying, hesitancy, straining, dysuria, acute urinary retention, elevated residual urine, frequency, urinary incontinence, recurrent UTIs, hematuria, and urethral pain.

109
Q

How is the buccal graft harvested for urethroplasty?

A

The graft is marked to the desired length, hydrodissected using lidocaine with epinephrine, incised at the edges, and then dissected free from underlying tissues.

110
Q

What is the first documented report of Female Urethral Stricture (FUS)?

A

The first reported case of FUS was in 1828.

111
Q

What are the main reported causes of FUS?

A

Iatrogenic injury, trauma, urinary tract infections (UTIs), inflammation, catheter-related inflammation, and surgeries like diverticulectomy, mesh removal, radiation, vaginal reconstruction, and female genital mutilation.

112
Q

What is the importance of cystoscopy under anesthesia in diagnosing FUS?

A

Cystoscopy under anesthesia is valuable in instances of diagnostic uncertainty.

113
Q

Describe the three stages of uroflowmetry results presented in the document for diagnosing urethral stricture.

A

Initial low flow with elevated PVR, return to bell-shaped curve post-dilation, and recurrence with plateau/mesa-shaped uroflow.

114
Q

What are the recommended options for repeated endoscopic treatment of extensive or recurrent FUS?

A

Repeated endoscopic treatment is generally not recommended for extensive or recurrent strictures due to high recurrence rates.

115
Q

Which graft is most commonly used in female urethral reconstruction?

A

Buccal mucosa is the majority of oral grafts used in female urethral reconstruction.

116
Q

What is the recurrence-free rate at 12 months for women undergoing vaginal flap urethroplasty with either an advancement flap (Blandy) or tubularized flap (Orandi)?

A

77% of women were recurrence-free at 12 months.

117
Q

What is the preferred catheter size and duration of catheterization postoperatively according to the document?

A

Nonlatex, 16Fr-18Fr urethral catheters for a duration of about 14 days.

118
Q

What are the common surgical reconstruction options for Female Urethral Stricture (FUS)?

A

Options include urethral dilation, urethrotomy, urethroplasty (ventral, dorsal, combined), flap urethroplasty (Blandy, Orandi), and graft urethroplasty using buccal mucosa.

119
Q

When is urethral dilation considered as a treatment for FUS?

A

Urethral dilation is used to stretch the lumen without worsening scarring, typically for less extensive strictures.

120
Q

Describe the Blandy technique for flap urethroplasty.

A

The Blandy technique involves an inverted U incision in the anterior vaginal wall, flap development, incision, calibration, suturing, and closure.

121
Q

What are the considerations for selecting the appropriate surgical approach for a urethral stricture?

A

Considerations include stricture characteristics (location, length, etiology), patient goals and preferences, surgeon expertise, and available techniques.

122
Q

What are the challenges and recommendations specific to female urethrotomy?

A

Urethrotomy involves incision of the urethral scar tissue and can be performed with a cold knife, electrocautery, or laser. Challenges include the specificity of the female urethra and careful consideration of the type and location of the stricture.

123
Q

When is graft urethroplasty using buccal mucosa considered for FUS?

A

Graft urethroplasty, predominantly using buccal mucosa, is considered in more complex cases of reconstruction and adapts methods used in male urethral reconstruction.

124
Q

What are the potential complications of anterior vaginal flap urethroplasty (“Blandy”)?

A

Potential complications include spraying urinary stream and vaginal voiding.

125
Q

What are the common symptoms of a Female Urethral Stricture (FUS)?

A

Symptoms can include slow flow, incomplete bladder emptying, urine spraying, hesitancy, straining, dysuria, acute urinary retention, elevated residual urine, frequency, urinary incontinence, recurrent UTIs, hematuria, and urethral pain.

126
Q

What are the typical findings of overactive bladder?

A

Overactive bladder is characterized by symptoms of urinary urgency, frequency, and urgency incontinence, often without an obvious cause

127
Q

What is a Skene’s duct cyst, and what are its typical symptoms?

A

A Skene’s duct cyst is a benign cyst located near the urethra, often asymptomatic but can cause dysuria or urinary frequency if large.

128
Q

What is pseudo detrusor sphincter dyssynergia, and how is it diagnosed?

A

Pseudo detrusor sphincter dyssynergia is a condition where the urinary sphincter muscle does not relax properly during voiding. Diagnosis usually involves urodynamic testing, and symptoms may include difficulty urinating and high post-void residual volumes.

129
Q

What is the significance of a normal uroflow with a maximum flow rate of 25 mL/s and a post-void residual of 30 mL?

A

A normal flow rate and low post-void residual indicate normal bladder emptying and are not typical for conditions that cause obstruction or significant retention.

130
Q

What are the limitations of endoscopic dilation for treating Female Urethral Stricture (FUS)?

A

Endoscopic dilation has minimal risks but high recurrence rates, especially for extensive or recurrent strictures.

131
Q

Describe the Blandy procedure (anterior vaginal mucosal flap urethroplasty) and its typical applications.

A

The Blandy technique involves an inverted U incision in the anterior vaginal wall, flap development, and closure. It’s used for anterior vaginal flap urethroplasty but may have complications like spraying urinary stream and vaginal voiding.

132
Q

What is a buccal graft dorsal urethroplasty, and when is it used?

A

Buccal graft dorsal urethroplasty involves using a graft from the mouth (buccal mucosa) placed on the dorsal side of the urethra. It’s used for more complex reconstructions and can be considered when other methods have failed.

133
Q

When is a buccal or vaginal graft ventral urethroplasty considered?

A

Buccal or vaginal graft ventral urethroplasty involves placing a graft on the ventral side of the urethra. It may be suitable when there’s a lack of ventral urethral plate or when other methods like flap techniques have failed.

134
Q

What are meatotomies, and why might they not be suitable for the given scenario?

A

Meatotomy involves an incision of the urethra at 6 o’clock rather than excision of the distal urethra. It may not be suitable for recurrent strictures following several procedures, as described in the question.

135
Q
A
136
Q

The male urethra is about___ cm long. The anterior urethra, which is surrounded by the ____, is approximately___ and lies within the penis distally and the perineum proximally. The anterior urethra can be further subdivided into the ____; the ___, which is surrounded by the ___ ; and the ___. The posterior urethra is ___ long and lies within the pelvis proximal to the ____. It can be further subdivided into the ___, __, and ___

A

The male urethra is about 18 to 20 cm long. The anterior urethra, which is surrounded by the corpus spongiosum, is approximately 16 cm and lies within the penis distally and the perineum proximally. The anterior urethra can be further subdivided into the pendulous or penile urethra; the bulbar urethra, which is surrounded by the bulbospongiosus muscle; and the fossa navicularis. The posterior urethra is 4 cm long and lies within the pelvis proximal to the corpus spongiosum. It can be further subdivided into the preprostatic or bladder neck, prostatic, and membranous urethra

137
Q

The only absolute contraindication to urethral catheterization is a ___ or a history of ___

A

The only absolute contraindication to urethral catheterization is a suspected or confirmed urethral injury or a history of bladder neck closure or repair.

138
Q

If BPH is suspected, ideally the clinician should use at least an ___

A

If BPH is suspected, ideally the clinician should use at least an 18-Fr catheter with a coudé tip.

139
Q

Newborn males born with ___ may require urgent catheterization. A blunt-tip __ catheter can be placed in ice and then shaped with an anterior curve to allow the catheter to pass anterior to the valves.

A

Newborn males born with posterior urethral valves may require urgent catheterization. A blunt-tip 5-Fr catheter can be placed in ice and then shaped with an anterior curve to allow the catheter to pass anterior to the valves.

140
Q

The clinician should obtain a thorough history and all prior operative records before instrumentation. If a ___ has been performed, obviously urethral catheterization should be avoided

A

The clinician should obtain a thorough history and all prior operative records before instrumentation. If a bladder neck closure has been performed, obviously urethral catheterization should be avoided

141
Q

A 16-Fr catheter is approximately ____ cm in outer diameter.

a. 16
b. 10.4
c. 8.7
d. 5.3

A

d. 5.3. To calculate French size approximately, divide by 3

142
Q 
The most common cause of inability to catheterize an Indiana pouch
is \_\_\_\_\_.
a. perforation
b. catheter malfunction
c. overdistension
d. none of the above
A

Overdistension. Overdistension is the most common reason for
catheterization difficulty. If the catheter is forced, a perforation in
the channel will be likely. A 21-gauge needle can be placed into the
reservoir. After drainage, a catheter will usually pass without
difficulty

143
Q

A urostomy should never be catheterized.

a. T
b. F

A

. b. F. Catheterizing a urostomy gently can be performed without
risk. Occasionally, catheterizing the stoma may be therapeutic in
cases such as stomal stenosis or parastomal hernia

144
Q

Catheter-associated urinary tract infection is the most common type
of health care–associated infection
a. T
b. F

A

a. T. Unfortunately, this is true based on a Centers for Disease
Control and Prevention report. Decreasing catheter use should
decrease the hospital-acquired infection rates

145
Q 
The incidence of bladder cancer in spinal cord patients with chronic
catheters is \_\_\_\_\_\_\_.
a. 1%
b. 2%
c. 3%
d. 4%
e. 6%
A

a. 1%. There are retrospective studies that do show what appears to
be an increased risk of bladder cancer. Some recommend
surveillance after 8 years of chronic catheterization.

11. Trauma y Reconstruccion (1018) (6 decks)

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