The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.

1. URETHRAL STRICTURE
PRESENTED BY:
MR: ABHAY RAJPOOT

2. ANATOMY OF URETHRA
 The bladder empties through the urethra and out of the body (called
voiding). The female urethra is much shorter than the male's. In males,
urine must travel a longer distance from the bladder through the penis.
 In males, the first 1" to 2" of the urethra that urine passes through is called
the posterior urethra.
The posterior urethra includes:
 The bladder neck (the opening of the bladder)
 The prostatic urethra (the part of the urethra by the prostate)
 The membranous urethra
 A muscle called the external urinary sphincter

4. INTRODUCTION
The urethra's main job in males and females is to pass urine
outside the body. This thin tube also has an important role in
ejaculation for men. When a scar from swelling, injury or
infection blocks or slows the flow of urine in this tube, it is called
a urethral stricture. Some people feel pain with a urethral
stricture.

6. DEFINITION
A urethral stricture involves scarring that narrows the tube that
carries urine out of your body (urethra). A stricture restricts
the flow of urine from the bladder and can cause a variety of
medical problems in the urinary tract, including inflammation
or infection.

7. INCIDENCE
Urethral stricture is a relatively common disease in men with an
associated prevalence of 229-627 per 100,000 males, or 0.6% of the at risk
population, who are typically older men. In patients with urethral
stricture disease older than 60 years, 6.5% underwent retrograde
urethrography (RUG) studies

8. CAUSES
 Trauma to the urethra
 Infection such as a sexually transmitted disease
 Damage from surgical tools
 Conditions that cause swelling
 In most cases, no cause can be found.
In adults, urethral strictures are most often due to:
 Injury from a fall onto the scrotum or perineum
 Prostate surgery
 Kidney stone removal
 Urinary catheterization
 Other surgical tools

9. PATHOPHYSIOLOGY

10. Posterior Urethral Stricture
 Posterior urethral strictures happen in the first 1" to 2" of the urethra. This
kind of stricture is due to an injury linked to a pelvic fracture (e.g., motor
vehicle or industrial accident). In these cases the urethra is disrupted, or
completely cut and separated. Urine cannot pass..
Anterior Urethral Stricture
 Anterior urethral strictures happen in last 9" to 10" of the urethra. This kind
of stricture is caused by:
 trauma from a straddle injury (from falls onto objects where the legs are on
either side)
 direct trauma to the penis
 catheterization

11. SIGN AND SYMPTOMS
 Bloody or dark urine
 Blood in semen
 Slow or decreased urine stream
 Urine stream spraying
 Pain with urinating
 Abdominal pain
 Urethral leaking
 UTI in men
 Swelling of the penis
 Loss of bladder control

12. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Urethral imaging (x-rays or ultrasound)
 Urethroscopy (to see the inside of the urethra)
 Retrograde urethrogram
 Urethroscopy
The doctor gently places a small, bendable, lubricated scope ( a small viewing
instrument) into the urethra. It is moved up to the stricture. This lets the
doctor see the narrowed area. This is done in the office and helps your doctor
decide how to treat the stricture.

13.  Retrograde Urethrogram
This test is used to see how many strictures there are, and their position,
length and severity.
This is done as an outpatient X-ray procedure. Retrograde in this case means
"against the flow" of urine. Contrast dye is inserted into the urethra at the tip
of the penis. No needles or catheters are used.
The dye lets the doctor see the entire urethra and outlines the narrowed
area. It can be combined with an antegrade urethrogram
Dye inserted from below fills the urethra up to the injured area. Dye inserted
from above fills the bladder and the urethra down to the stricture. These
tests together let the doctor find the gap to plan for surgery.

15. PREVENTION
 Avoid injury to the urethra and pelvis.
 Be careful with self-catheterization
 Use lubricating jelly liberally
 Use the smallest possible catheter needed for the shortest time
 Avoid sexually transmitted infections.
 Gonorrhea was once the most common cause of strictures.
 Antibiotics have helped to prevent this.
 Infection can be prevented with condom use, or by avoiding sex with
infected partners.
 If a problem occurs, take the right antibiotics early. Urethral
strictures are not contagious, but sexually transmitted infections are

16. MANAGEMENT
There are many options depending on the size of the blockage
and how much scar tissue is involved.
Treatments include:
 Dilation – enlarging the stricture with gradual stretching
 Urethrotomy– cutting the stricture with a laser or knife
through a scope
 Open surgery – surgical removal of the stricture with
reconnection and reconstruction, possibly with grafts
(urethroplasty)

17. SURGICAL MANAGEMENT
Anastomotic Urethroplasty
 This method is usually reserved for short urethral strictures. In this case, a cut is
made between the scrotum and rectum. The urethra can then be reconnected after
removing the stricture. A small, soft catheter is left in the penis for 10 to 21 days. It
is then removed after an X-ray is taken to make sure the repair has healed.
Substitution Urethroplasty
 When the stricture is long, tissue can be transferred to replace the section that had
the stricture. In difficult cases, substitution repairs may need to be done in stages.
The 3 kinds of substitution procedures are:
 Free graft
 Skin flap

18.  Free Graft
This method replaces or enlarges a section of the urethra using your own
tissue. The tissue may be skin (taken from the shaft of the penis) or, more
often, buccal mucosa (taken from inside the cheek). After surgery, you may
need a short hospital stay and use a catheter for 2 or 3 weeks.
 Skin Flap
With this surgery, flaps of skin are rotated from the penis to create the new
section of the urethra. This is needed when a graft needs to be long, and the
stricture is severe. These procedures are complex and should be done by a
surgeon with plastic surgery experience. After surgery, you may need a short
hospital stay and use a catheter for 2 or 3 weeks.

19. Anastomotic Urethroplasty

20. Substitution Urethroplasty

21. NURSING INTERVENTION