2. Male urethra -tubular structure - bladder
neck to the external urinary meatus
Parts - prostatic, membranous, bulbar and
penile urethra
urethral lining –proximal -transitional
epithelium, distally- stratified squamous cell
epithelium.
external urethral sphincter -innervated by
the pudendal nerve-S2, 3 and 4.
3.
4.
5.
6. Most common congenital abnormality of the
urethra.
Three features :
1 )external meatus opens on the underside
of the penis
2)ventral aspect of the prepuce is poorly
developed (the 'hooded prepuce')
3)ventral deformity of the erect penis
(chordee).
7.
8. TYPES :
Glanular hypospadias.-ectopic meatus is placed on
the glans penis,
Coronal hypospadias - meatus is placed at
junction of the underside of the glans and the
body of the penis.
Penile and penoscrotal hypospadias. -meatus is
on the underside of the penile shaft.
Perineal hypospadias-scrotum is bifid and the
urethra opens between its two halves.
TREATMENT
Surgery for urinary stream & cosmetic reasons.
Procedure for distal hypospadias is the
'tubularised incised plate' urethroplasty.
9. Urethral opening is on the dorsum of the penis
and is associated with the upward curvature of
the erect penis
10. Commonest cause - catheterisation
/cystoscope.
Heal by scarring –cause urethral stricture –
sites : submeatal area ,bulbar urethra,
membranous urethra
11. History of a blow to the perineum, usually due to
fall by astride injury.
Cycling accidents, loose manhole covers and
gymnasium accidents
Suspect urethral injury -cannot void, perineal
bruising and blood at the urethral meatus
Diagnosis -urethrography using water-soluble
contrast
Initial management -suprapubic catheter
Definitive management - Delayed urethroplasty
12. Seen in Fractured pelvis & extraperitoneal rupture
of the bladder
Features - urinary retention, blood at the urethral
meatus and a high riding prostate
Diagnosis by urethrogram using water-soluble
contrast
Initial management - ultrasound guidance
suprapubic catheter
If patient doesnot have blood at the urethral
mearus & not yet passed urine -single, gentle
attempt with 16F soft silicone catheter can be
tried
13.
14. The female urethra is around 2 to 3 cm long
extending from the bladder neck to the
external urethral meatus .
Continence is maintained by external striated
urethral sphincter.
There is extra support from surrounding
pelvic floor musculature.
16. Urethrocele reflect weakening of the Tissues
that hold the urethra in place causing it to
move and to put pressure on the vagina
leading to the prolapse of the anterior distal
wall of the vagina.
They occur in conjunction with prolapse of
the bladder into the vagina.
Prolapse occurs in later life and is usually in
part due to the trauma of childbirth
17. Urethral strictures can occur following
urethritis or Trauma of a difficult labour .
Urinary retention is an occasional
consequence and is usually chronic.
True stricture in women respond well to
urethral dilatation.
18. Idiopathic condition having an abnormal
myotonic discharge in the striated urethral
sphincter that can be detected by sphincter
electromography.
It is often associated with polycystic ovaries
and causes urinary retention in
Urethral dilatation is ineffective and the
retention is best treated by intermittent self
catheterization .
Sacral neuromodulation can be effective in
some cases
19. Urethral diverticula are more commonly seen in
women.
Occur due to rupture of distended urethral
gland or injury to the urethra during childbirth.
Urine within the diverticulum become infected
causing local pain and repeated bouts of the
cystitis .
Purulant urine is discharged if the urethra is
compressed with finger placed in the vagina.
Diagnosis - MRI or transvaginal ultrasound
Excision of the diverticulum through the
anterior vaginal wall is effective.
20. This is common in elderly women.
It present as soft Raspberry like pedenculated
granulamatous mass about the size of pea,
attached to the posterior urethral wall near the
external meatus.
it is composed of highly vascular connective
tissue stroma infiltrated with pus cells.
There may be frequency of micturition and
urethral pain afterwards.
Treatment is by excision and diathermy
coagulation of the base of the stalk.
The patient should be given antibiotics to treat
the underlying chronic urethritis.
21. Papillomata acuminata are the same as the
sexually transmitted warts that occur on the
penis.
Papillomata acuminata may grow to a larger
size during pregnancy that they obstruct the
labour and necessitate a c- section.
22. This occurs twice as often in women as in
men.
Malignant swellings of the urethra feels
harder than benign ones.
Treatment by radiotherapy or radical surgery
but it is often ineffective.
The overall prognosis is poor.
