The document discusses urethral strictures and hydronephrosis, covering their causes, symptoms, diagnostics, and management. Urethral strictures result from narrowing of the urethra affecting urine flow, with various treatments including surgery and catheterization. Hydronephrosis is characterized by kidney dilation due to urine outflow obstruction, with causes ranging from tumors to congenital issues, and is also managed through surgical interventions.

1. URETHRAL STRICTURES
Prepared by
Ms. Maira Shaheen

2. LEARNING OBJECTIVES
By the end of the session learners will be able to:
Discuss the causes, Pathophysiology and
manifestation of the following Urethral strictures and
Hydronephrosis
Discuss Assessment, Diagnostic Test, Medical,
Surgical and Nursing Management of Urethral
strictures and Hydronephrosis
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3. WHAT IS A URETHRAL STRICTURE?
 A urethral stricture is a
narrowing in any part of
the urethra – the tube
that drains urine from
the bladder. This
impairs normal urine
flow.
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4. ETIOLOGY
 Urethral injury, disease, catheterization or surgery
that results in inflammation or scar tissue.
 Urethral infections, such as gonorrhea.
 A tumor in the urethra (rarely)
 A complication of radiation treatment of the pelvis
 May be congenital or acquired.
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5. RISK FACTORS
 Increased risk is associated with men who have a
history of sexually transmitted disease, repeated
episodes of urethritis, and benign prostatic
hyperplasia. There is also increased risk of
stricture after an injury or trauma to the pelvic
region. Any instrumentation entering the urethra
increases the chance of developing urethral
strictures.
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6. SIGNS AND SYMPTOMS
 Dysuria.
 Hematuria.
 Weak stream.
 Splaying of the urine stream.
 Nocturia.
 Incomplete emptying.
 Pain with bladder distention.
 Urinary tract infection (fever and malaise may be
present with a urinary tract infection.
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7. DIAGNOSTICS
 Voiding cystourethrography (pictured)
 Cystoscopy
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8. MEDICAL MANAGEMENT
 Surgery to correct
The condition – open
Urethroplasty.
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9. MEDICAL MANAGEMENT CONT’D
 Suprapubic catheter – inserted temporarily to drain
the bladder.
 Internal incision of the stricture via a cystoscope or
endoscope.
 Permanent catheter.
 Dilating the stricture by inserting a stent.
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10. NURSING INTERVENTIONS
 Adequate hydration – to decrease discomfort
when voiding
 Monitor urine output.
 Mild analgesics.
 Sitz baths – to encourage voiding.
 If urethroplasty is performed – splint the catheter
to support the catheter line. Do not cause tension
on the catheter.
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11. PROGNOSIS
 Without appropriate treatment, the stricture will
almost always recur. But, after surgical correction
or dilation the prognosis is favorable.
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12. HYDRONEPHROSIS
Prepared by
Ms. Maira

13. HYDRONEPHROSIS
 Dilatation of renal pelvis & calyces with
accompanying destruction of the kidney
parenchyma
 Usually due to partial obstruction to the outflow of
urine
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14. Hydronephrosis
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15. Cont…
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Normal kidney Hydronephrosis

16. Normal Intravenous Pyelogram (IVP)
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17. ETIOLOGY
 Primary or secondary
 Primary: idiopathic
 Secondary: maybe unilateral or bilateral
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18. CAUSES OF UNILATERAL
HYDORNEPHROSIS
 Maybe extramural, intramural or Intraluminal
 Extramural:

Pressure on the ureter by loaded sigmoid colon, gravid
uterus, uterine & ovarian tumors

Involvement of the ureter by malignant neoplasm outside it
e.g. carcinoma of the cervix, uterus, colon, rectum, prostate

Aberrant renal vessels

Idiopathic retroperitoneal fibrosis
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19. Cont…
 Intramural:
 Congenital stenosis or achalasia of
the PUJ
 Ureterocele
 Stricture
 Neoplasm of ureter
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20. Cont…
 Intraluminal:
 Calculus
 Congenital folds at the upper end
of the ureter
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21. Causes of bilateral hydornephrosis
 Due to pathologies in the urethra or the urinary bladder
 Causes in the urethra:

Pin – hole meatus
 Congenital valves

BPH & carcinoma of prostate

Stricture
 Carcinoma of cervix & uterus
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22. Cont…
 Due to pathologies in the urethra or the urinary
bladder
 Causes in the bladder:
 Calculus
 Neoplasms
 Sphincter dysfunction
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25. PATHOPHYSIOLOGY
 Dilatation of the renal pelvis & calyces
 Types of hydronephrosis:
 Pelvic type
 Renal type
 Pelvirenal type: most common type, both the
pelvis & calyces are equally dilated
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27. CLINICAL FEATURES
 May depend on unilateral, intermittent or bilateral
hydronephrosis
 Unilateral hydronephrosis:
 Dull ache & sense of weight on the affected
side of the loin
 Causes of the hydronephrosis
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28. Cont…
 Intermittent hydronephrosis:
 Dietl’s crisis
 Bilateral hydronephrosis:
 Features of the causes
 Bilateral renal swelling
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29. SPECIAL INVESTIGATIONS
 Straight abdomen of the X- ray
 Excretory urography
 Retrograde urography
 Ultrasound
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30. TREATMENT
Secondary hydronephrosis: treatment of the cause
 Primary hydronephrosis:
 Pyeloplasty:

Anderson- Hynes

Culp

Foley
 Nephrectomy
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34. PRINCIPLES OF PYELOPLASTY
 To reduce the size of the renal pelvis
 Excision of the UPJ
 The ureter is attached to the most dependent part
of the pelvis
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extraperitoneal flank
approach, bed of the twelfth
rib

36. Cont…
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38. REFERENCE
 Smeltzer, S. C., Bare, B. G., Hinkle, J. L., &
Cheever, K. H. (2010). Brunner and
Suddarth’s textbook of medical-surgical nursing
(12th ed.). Philadelphia:Lippincott Williams &
Wilkins.
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