Urethral stricture is an abnormal narrowing of the urethra caused by fibrosis due to injury or inflammation. It is most common in males and usually occurs around age 50. Symptoms include poor urine stream and retention. Diagnosis involves tests like cystoscopy and retrograde urethrogram. Treatment depends on location and severity but may include dilation, internal urethrotomy, or open urethroplasty surgery to repair or bypass the stricture. Effective drainage of the bladder is important to manage this condition.
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.
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.
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.
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.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
this power point presentation is made ideally according to criteria of ppt. with opener , energizes , bibliography ans much more criteria are followed.thank you..
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
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- Prix Galien International Awards Ceremony
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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3. INTRODUCTION
• Urethral stricture is an abnormal narrowing or loss of distensibility of
any part of the urethra as a result of fibrosis at the site of injury or
inflammation.
• It is a common cause of urinary retention in tropical Africa.
4. EPIDEMIOLOGY
• Urethral stricture is a relatively common disease in men with an
associated prevalence of 229-627 per 100,000 males
• It is commoner in males due to the length of the male urethra
• Mean age of occurrence is 50 years
5. RELEVANT ANATOMY OF THE MALE URETHRA
• The male urethra extends from the bladder neck and terminates at
the external urethral meatus.
• The male urethra measures about 20.5cm in length and comprises
two(2) part – the anterior and posterior urethra.
• The longer anterior urethra measures about 15cm and comprises the
bulbous and penile urethra
• The shorter posterior urethra comprises the prostatic and
membranous urethras.
7. RELEVANT ANATOMY OF THE MALE URETHRA
• The epithelium of the urethra is stratified or pseudo stratified in the
glans and transitional proximal to the glans.
• Lymphatics from the deep urethra drain into the hypogastric and
common iliac nodes while those of the meatus drain into the inguinal
nodes.
• Arterial supply is from the inferior vesical and internal pudendal
arteries with concomitant venous drainage.
8. AETIOLOGY
1. CONGENITAL : Pin hole meatus
Non meatal Stricture
2. TRAUMATIC: External trauma
Urethral instrumentation
Foreign body or urethral calculus.
3.POSTOPERATIVE:Transurethral procedures
4.INFLAMMATORY: Post gonococcal (70%)
Non specific urethritis
Schistosomiasis
Tuberculous urethritis
9. CLASSIFICATION
• Based on aetiology
• Proximal or Distal
• Permeable or Impermeable
• Passable or Impassable
• Single or Multiple
10. PATHOGENESIS
• Urethral stricture forms when the urethra heals by proliferation of
fibroblasts which later contracts.
• Post inflammatory strictures are usually confined to the anterior
urethra particularly the bulbous urethra.
• Instrumental injury usually occurs at the bulb but stricture following
prostatic surgery is found at the bladder neck.
• Urethral stricture following pelvic injuries usually occurs at the
membranous urethra
11. PATHOLOGY
Urethral stricture leads to
1. Dilatation of the urethra proximal to the stricture
2. Compensatory changes in the bladder musculature resulting in
hypertrophy, trabecculation, sacculation and diverticular formation.
3. Hypertrophy of the uretero-trigonal complex or vesicoureteral
reflux causing hydroureters and hydronephrosis.
4. Stasis of urine and subsequent infection of the urinary tract
13. CLINICAL FEATURES
• Although stricture following urethritis is formed within a year, it takes
on an average of about 20 years for symptoms to become apparent.
• Traumatic strictures on the other hand are symptomatic in two
months.
• Symptoms are usually insidious in onset and are usually LUS which
include poor stream, forking and spraying of urine, frequency,
hesitancy, dribbling, acute and chronic retention.
14. CLINICAL FEATURES
• It may present as a periurethral abscess, periurethral,scrotal or
perineal fistulae with dribbling of urine and as extravasation of urine.
• When infection occurs, symptoms of cystitis, prostatitis, epididymitis
and pyelonephritis can occur.
• In untreated cases uraemia may result from pyelonephritis and
hydronephrosis
15. CLINICAL FEATURES
• Examination of the external genitalia may reveal periurethral
induration, periurethral abscess, perineal urinary fistulae or
extravasation of urine.
• A visible or palpable bladder may be found if urinary retention
occurs.
• Digital rectal examination is done for the state of the prostate.
16. INVESTIGATIONS
• Urinalysis, Urine microscopy and culture.
• Blood urea and serum creatinine.
• IVU to see hydronephrosis and function of kidney.
• U/S abdomen.
• Plain pelvic or abdominal xrays
21. TREATMENT OPTIONS
TEMPORARY MEASURES
• Suprapubic Cystostomy
(i) Urinary retention
(ii) Urine diversion in fistulae
(iii) Temporary measure in uraemia
• Antibiotics for UTI
• Correction of electrolyte imbalance
23. TREATMENT OPTIONS
• SPECIFIC MEASURES
1. INTERMITTENT DILATATION : It is palliative but adequate for most
patients. This is done using bougies which could be
(i) flexible filiform bougie
(ii) flexible gum elastic bougie
(iii) metal bougie (lister’s, Clutton’s and straight)
Indication – passable incomplete strictures
Intermittent dilatation is done at increasing intervals starting with a
small sized bougie .
25. TREATMENT OPTIONS
• Complications of Intermittent Dilatation
(i) Infection
(ii) Bleeding and clot retention
(iii) Extravasation of urine
(iv) Fistulae
Given the above complications, it is of utmost importance dilatation is
done under strict asepsis and bougies should be passed gently.
26. TREATMENT OPTIONS
2. VISUAL INTERNAL URETHROTOMY
This involves incising of the stricture under direct vision using a
cystoscope and a cold blade urethrotome e.g. Sachse urethrotome.
Indication – short, uncomplicated impassable strictures
• After internal urethrotomy, it is advisable to splint the urethra with in
indwelling catheter for 2-7 days and longer 14-21 days for difficult
strictures.
29. TREATMENT OPTIONS
3. URETHROPLASTY
It is an open plastic repair of the urethra.
Indications
(i) Failed conservative management i.e Intermittent dilatation and
urethrotomy
(ii) Very long strictures or complete strictures with extensive spongiofibrosis
(iii) Complicated strictures with periurethral abscess, calculi or neoplasia.
30. TREATMENT OPTIONS
• Urethroplasty can be anastomostic or substitutional.
• Grafts include the buccal mucosa, bladder mucosa, penile skin, scrotal skin, prepuce, post
auricular skin.
• Meatal Stenosis : Meatoplasty
• Anterior urethra Strictures :
(i) Two stage urethroplasty such as the Swinney technique which involves the initial laying open
of the stricture and subsequent reconstruction of the urethra using a graft/flap.
(ii) Free Graft urethroplasty
(iii) Skin island flap implantation
(iv) End to end anastomosis
32. TREATMENT OPTIONS
• Posterior urethra strictures
(i) anastomostic urethroplasty
(ii) Skin island flap implantation
• Newer trends include laser urethrotomy and urethral stenting
33. TREATMENT OPTIONS
• PROBLEMS OF URETHROPLASTY
(i) Infection
(ii) Prolonged hospital stay
(iii) Necrosis of flap/graft
(iv) Leakage and fistula formation
(v) Restenosis
34. CONCLUSION
• Urethral strictures arise from various causes and can result in a range
of manifestations, from an asymptomatic presentation to severe
discomfort secondary to urinary retention
• Establishing effective drainage of the urinary bladder can be
challenging, and a thorough understanding of urethral anatomy and
urologic technology is essential
• Hence, early consultation of a urologist is of utmost importance
35. REFERENCES
• SRB’s Manual of Surgery (3rd Edition)
• Principles and Practice of Surgery by E.A. Badoe et al
• https://emedicine.medscape.com/article/450903-overview