STRICTURE URETHRA CLASSIICATION -I I: Aetiologically. 2. Congenital. 3. Inflammatory: Post-gonococcal is most common Gonococcal stricture occurs one year after infection. Retention develops only 10–15 years later.

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STRICTURE
URETHRA

2. STRICTURE
URETHRA

4. STRICTUREURETHRA
CLASSIICATION-I
I: Aetiologically.
2. Congenital.
3. Inflammatory:
a. Post-gonococcal
• is most common
• Gonococcal stricture
occurs one year after
infection.
• Retention develops
only 10–15 years
later.

5. • Commonin the bulb
of urethra especially in
the roof.
• Here multiple
strictures are common,
proximal stricture is
the narrowest.
b. Tuberculous.
c. Other infection(urethritis)
4. Traumatic:
• Bulbous
• membranous.
5. Post-instrumentation:
• Catheter,
• dilator,
• cystoscope.
6. Postoperative:
• Prostate surgery
• urethrostomy.
ClassificationII:
1. Proximal: Common in
bulbous urethra (70%).
2. Distal: Congenital (in the
external meatus). Often
traumaticin children.

6. ClassificationIII:
1. Permeable: Permitsurine
to pass.
2. Impermeable
ClassificationIV:
1. Passable: Allows catheter
to pass.
2. Impassable.
ClassificationV: It can be
single or multiple.
ClassificationVI:
• According to the part
involved. In the roof (most
common)or in the floor.
CLINICAL FEATURES
• ™
Poor urinarystream™
Forking and spraying of
the stream™
• Incomplete emptying ™
• Frequency
• dysuria ™
• Retention and oftenwith
overflow™
• Pain,
• burning micturition,
• suprapubic tenderness ™

7. • Thickening and button-like
feeling in bulbar urethra
(Bulbous urethra is felt
clinicallyby lifting the
scrotumin midline in the
perineum)
INVESTIGATION
• Urine microscopyand
culture
• Blood urea and serum
creatinine.
• IVUto see hydronephrosis
and function of kidney.
• Ultrasoundabdomen.
• X-rayof pelvis to see old
fracture with history of
trauma.
• Ascending urethrogramis
an essential investigation
to see the site, type, extent
and false passage.
• The dye is injected through
suprapubic needle
puncture into the bladder
and visualisationis done
using C-Armimage
intensifier.
• Urodynamicstudies.
• Urethroscopy

8. TREATMENT
1. Intermittent dilatation:
Gradual dilatation
↓
initially with thin dilators
↓
later withthicker dilators of
increasing size.
↓
Dilatationshould be donein OT
under aseptic precaution.
↓
Shouldavoidforcible dilatation
or over dilatation.
↓
Dilatation is done “Once a week
for one month, once a month
for one year, and later once a
year.
Dilators used:
• a. Lister’s dilator [hasgot
olivetip(blister)].
• b. Clutton’s dilator.
• c. Filiformbougies.

9. Complications of dilatation ™
• Infection
• bleeding due to trauma™
• False passage ™
• Fistula formation
2. Visual internal cystoscopic
urethrotomy or stricturotomy:
Here using cystoscope
↓
stricture is visualisedand is cut
at 12 o’clockposition
↓
until it bleeds (fibrous tissue is
cut completely).
↓
After that Foley’s catheter is
passed and kept in position for
48 hours.
COMPLICATION
• Retention of urine ™
• Urethral fistula ™
Infection
• Urethritis
• Cystitis
• pyelonephritis ™
• Urethral diverticula™
• Periurethral abscess™
• Bilateral hydronephrosis ™

10. • Stone formation ™
• Renal failure ™
• Due to straining
• Hernia
• Haemorrhoids
• rectal prolapse
REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

11. A
Special Thanks
To A Very
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