useful for the nurses

1. Urethral Stricture
Mr Yogendra Mehta
Lecturer, HOD(Adult Health Nursing)
TU IOM BNC

2. Introduction
• The urethra is a tube that carries urine from the bladder so
it can be expelled from the body.
• Usually the urethra is wide enough for urine to flow freely
through it.
• When the urethra narrows, it can restrict urinary flow. This
is known as a urethral stricture.
• Urethral stricture is a medical condition that mainly affects
men

3. Contd....

4. Contd....
• This is usually due to tissue
inflammation or the presence of scar
tissue.
• Scar tissue can be a result of many
factors.
• Young boys who have hypospadias
surgery (a procedure to correct an
underdeveloped urethra) and men
who have penile implants have a
higher chance of developing urethral
stricture

5. Causes/Risk Factors
• A straddle injury is a common type of trauma that can lead
to urethral stricture.
Examples: falling on a bicycle bar or getting hit in the area
close to the scrotum.
• Pelvic fractures
• Catheter insertion
• Radiation
• Surgery performed on the prostate
• Benign prostatic hyperplasia

6. Contd....
Rare causes include:
• a tumor located in close proximity to the urethra
• untreated or repetitive urinary tract infections
• the sexually transmitted infections (STIs) gonorrhea or
chlamydia

7. Clinical Features
Urethral stricture can cause symptoms mild to severe. Some
of the signs of a urethral stricture include:
• weak urine flow or reduction in the volume of urine
• sudden, frequent urges to urinate
• a feeling of incomplete bladder emptying after urination
• frequent starting and stopping urinary stream
• pain or burning during urination
• inability to control urination (incontinence)

8. Contd....
• pain in the pelvic or lower abdominal area
• urethral discharge
• penile swelling and pain
• presence of blood in the semen or urine
• darkening of the urine
• inability to urinate (this is very serious and requires
immediate medical attention)
•

9. Diagnosis
• History Taking
• Physical Examination:
 A simple physical examination of the penis.
 Observe redness (or urethral discharge) and find out if one
or more areas are hard or swollen.
• measuring the rate of flow during urination
• analyzing the physical and chemical properties of urine to
determine if bacteria (or blood) are present

10. Contd....
• Cystoscopy: inserting a small tube with a camera into the
body to view the inside of the bladder and urethra (the
most direct way to check for stricture).
• Measuring the size of the urethral opening
• Tests for chlamydia and gonorrhea

11. Staging

12. Management Approaches
• Unsurgical
 Primary mode of treatment is to make the urethra wider
using a medical instrument called a dilator.
 Doctor will begin by passing a small wire through the
urethra and into the bladder to begin to dilate it.
 Over time, larger dilators will gradually increase the width
of the urethra.
 Another nonsurgical option is permanent urinary catheter
placement.
 This procedure is usually done in severe cases.
 It has risks, such as bladder irritation and urinary tract
infection.

13. Contd....
• Surgery
 Open urethroplasty is an option for longer, more severe
strictures.
 This procedure involves removing affected tissue and
reconstructing the urethra.
 Results vary based on stricture size.
 Internal Urethrotomy
 Urethroplasty

14. Contd....
 Internal Urethrotomy
• Surgeon will first insert a scope into the urethra so they
can see the stricture.
• Then, they’ll use a small, sharp surgical instrument, called
an endoscopic scalpel, to cut the stricture open.
• They’ll do this in one or two places to increase the
diameter of your urethra.

16. Contd....
 Urethroplasty
• Primary anastomotic urethroplasty
 surgeon will cut out the diseased section that’s causing the
stricture and reattach the healthy ends.
 They’ll usually perform this procedure for short segment
strictures.

17. Contd....
• Incision and grafting, or ventral onlay grafting
• Urethroplasty is generally reserved for longer segments of
stricture.
• In this procedure, your surgeon will cut open the stricture
on the bottom side.
• Then, they’ll use a piece of tissue to enlarge the diameter
of the urethra.
• The tissue usually comes from the inner cheek, called the
buccal mucosa.

18. Urethroplasty

19. Contd....
• Urine flow diversion
 Complete urinary diversion
 This surgery permanently reroutes the flow of urine to an
opening in the abdomen.
 It involves using part of the intestines to help connect the
ureters to the opening.
 Urinary diversion is usually only performed if the bladder is
severely damaged or if it needs to be removed.

20. Contd....

21. Pre/Post Nursing Care
• Provide routine preoperative care.
• Assess knowledge of the proposed surgery and its long-
term implications, clarifying misunderstandings and
discussing concerns.
• Begin teaching about postoperative tubes and drains, self
care of stoma, and control of drainage and odor.
• Assist in identifying stoma site, avoiding folds of skin,
bones, scar tissue, and the waistline or belt area.
• Be sure to consider the client’s occupation and style of
clothing.
• Assess size, color, and condition of the stoma and
surrounding skin every 2 hours for the first 24 hours, then
every 4 hours for 48 to 72 hours.

22. Contd....
• The site should be visible to the client and accessible for
manipulation.
• Care is taken to place the stoma away from areas of constant
irritation by clothing or movement.
• It should be located so that the client can cover and disguise the
collecting device, maintain the seal to prevent leakage, and
effectively cleanse and maintain the site.
• Monitor intake and output carefully, assessing urine output
every hour for the first 24 hours, then every 4 hours or as
ordered.
• Call the physician if urine output is less than 30 mL per hour.
• Tissue edema and bleeding may interfere with urinary output
from stoma, catheters, or drains. Maintenance of urine out

23. Contd....
• flow is vital to prevent hydronephrosis and possible renal
damage.
• A urine output of at least 30 mL per hour is necessary for
effective renal function.
• Assess color and consistency of urine.
• Expect pink or bright red urine fading to pink and then
clearing by the third postoperative day.
• Urine may be cloudy due to mucus production by bowel
mucosa.
• Bright red blood in the urine from a urinary diversion may
indicate hemorrhag.,

24. Contd....
• Expect the stoma to appear bright red and slightly edematous
initially.
• Slight bleeding during cleansing is normal.
• Irrigate the ileal diversion catheter with 30 to 60 mL of normal
saline every 4 hours or as ordered.
• Mucus produced by the bowel wall may accumulate in the
newly devised reservoir or obstruct catheters.
• Monitor serum electrolyte values, acid-base balance, and renal
function tests such as BUN and serum creatinine.
• Teach the client and family about stoma and urinary diversion
care, including odor management, skin care, increased fluid
intake, pouch application and leakage prevention, self-
catheterization for clients with continent reservoirs, and signs of
infection and other complications.