URETHRAL STRICTURE is the narrowing of urethra that is often due to the scarring as result of infections like STDs, inflammatory processes such as prostate enlargement, trauma, surgical operations like circumcision, kidney stone removal, intermittent or long term catheterization and lichen sclerosis.
2. INTRODUCTION
The urethra is the tubular structure lined by stratified columnar
epithelium that convey urine from the bladder to an external opening in
the perineum as its primary role in both male and female
It also play an important role in ejaculation for men
It is lined by mucous secreting glands that act as protection from
corrosive urine contents
Urethral strictures is the narrowing of urethral lumen that is mostly due
to the scaring
3. SCOPE
Normal anatomy and physiology
Epidemiology
Etiology/Causes of urethral stricture
Types of urethral stricture
Symptoms and Signs
Clinical diagnosis
Management
Prevention
5. MALE URETHRA
The male urethra is approximately 15-20cm long. In addition to
urine, the male urethra transports semen
Anatomically, male urethra is made of three parts(from
proximal to distal)
Prostatic urethra
Membranous urethra
Bulbous/Penile urethra
6. Prostatic,Membranous, Penile urethra are supplied by the
inferior vesical artery (branch of the internal iliac artery),
bulbourethral artery (branch of the internal pudendal artery) and
direct branches of the internal pudendal artery respectively
The nerve supply to the male urethra is derived from the
prostatic plexus, which contains a mixture of sympathetic,
parasympathetic and visceral afferent fibres
The prostatic and membranous portions drain to the obturator
and internal iliac nodes, while the penile urethra drains to the
deep and superficial inguinal nodes
7.
8. FEMALE URETHRA
Short urethra (approximately 4cm)
It begins at the neck of the bladder, and passes inferiorly
through the perineal membrane and muscular pelvic floor
The urethra opens directly onto the perineum, in an area
between the labia minora, known as the vestibule.
The urethral orifice is located anteriorly to the vaginal opening,
and 2-3cm posteriorly to the clitoris
9. The distal end of the urethra is marked by the presence
Skene’s glands(correspondant of prostate in male) on either
side of the urethra
The blood supply is via the internal pudendal ertery/vein,
vaginal arteries/veins and inferior vesical branches of the
vaginal arteries/veins
The nerve supply is from the vesical plexus and the pudendal
nerve.Visceral afferents from the urethra run in the pelvic
splanchnic nerves
The proximal and distal female urethra drains into the internal
iliac nodes and superficial inguinal lymph nodes respectively
10.
11. EPIDEMIOLOGY
0.6% of the population are at risk
Common in the elder of over 55 years old
Males are affected than females
12. ETIOLOGY/CAUSES
The narrowing of urethra is secondary to the scaring as resul of:
Infections(urethritis and STDs)
inflammatory Processes(like enlarged Prostate)
Post-traumat(endoscopy, intermittent or long-term use of
catheter, injury to bladder or pelvis)
Post prostate cancer treatment or surgical operation like
circumcision
Lichen sclerosis
13. Anterior urethra(most common) affect spongy ption of
urethra and is secondary to scarring in the spongy erectile
tissue of the corpus spongiosum
Posterior which affect proximal portion(one to two inches)
and is due to a fibrotic process that narrows the bladder neck
and usually results from a distraction injury secondary to
trauma or surgery, such as radical prostatectomy
TYPES OF URETHRAL STRICTURE
14.
15. SYMPTOMS AND SIGNS
bloody or dark urine/ blood in semen
Abdominal pain
Decreased urine stream
Incomplete bladder empting
Spraying of the urine stream
Difficulty, staining, or pain when urinating
Increased urge to urinate or more frequent urination
swelling of the penis, urethral leaking and UTIs in men
loss of bladder control
16. CLINICAL DIAGNOSIS
Urinalysis
Urinary flow test
Urethral ultrasound to evaluate the length of the stricture
Pelvic ultrasound to look PVR
Pelvic magnetic resonance imaging (MRI) to assess whether
your pelvic bone is affecting or is affected by your condition
17. Retrograde urethrogram: uses X-ray images to check for a structural
problem or injury of the urethra as well as the length and location of
the stricture along the urethra
Cystoscopy examines your urethra and bladder using a thin, tubelike
device fitted with a lens (cystoscope) to view these organs
Perform biopsy for suspected lichen sclerosus (LS), or if urethral
cancer is suspected
20. REFERENCE
Netter’s atlas of Human Anatomy, 6th ed
Urology-handbook for medical students, 1E 2001
Urology reference guide
https://emedicine.medscape.com/article/450903-overview
https://emedicine.medscape.com/article/450903-overview