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Urethral Strictures, causes and management
- 1. 11/08/2025 Professor Bhavani Rao URETHRALSTRICTURES - CLINICAL FEATURES, INVESTIGATIONS & MANAGEMENT Prof. Reddi Bhavani Rao MS General surgery
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- 8. 11/08/2025 Professor Bhavani Rao URETHRALSTRICTURES INTRODUCTION • Fibrotic narrowing of urethra due to scarring. • Causes obstructive urinary symptoms and complications. • Common in males, especially post instrumentation or trauma.
- 9. 11/08/2025 Professor Bhavani Rao ETIOLOGY POSTERIORURETHRAL VALVES
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- 12. 11/08/2025 Professor Bhavani Rao INFECTIVE:GONOCOCCAL/NON- GONOCOCCAL URETHRITIS
- 13. 11/08/2025 Professor Bhavani Rao TRAUMATIC PELVICFRACTURE LEADING TO POSTERIOR URETHRAL INJURY
- 14. 11/08/2025 Professor Bhavani Rao ETIOLOGY •Congenital: Rare. • Acquired: • Iatrogenic: catheterization, instrumentation. • Infective • gonococcal/non-gonococcal urethritis. • Traumatic • pelvic fractures. • Idiopathic.
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- 17. 11/08/2025 Professor Bhavani Rao URETHRALSTRICTURE CLINICAL FEATURES • Obstructive symptoms: poor stream, straining, dribbling. • Irritative symptoms: urgency, frequency, dysuria. • Other: UTI, perineal pain, urinary retention, spraying of urine.
- 18. 11/08/2025 Professor Bhavani Rao EXAMINATIONFINDINGS • Palpable perineal induration. • Distended bladder. • Perineal/scrotal fistula or abscess. • Rectal exam to assess prostate.
- 19. 11/08/2025 Professor Bhavani Rao INVESTIGATIONS- BASIC • Urine Routine & Culture - Rule out infection. • Serum Creatinine, Blood Urea - Renal function. • Ultrasound KUB + PVR urine.
- 20. 11/08/2025 Professor Bhavani Rao UROFLOWMETRY Qmax<10 ml/sec is suggestive of obstruction
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- 25. 11/08/2025 Professor Bhavani Rao INVESTIGATIONS- SPECIFIC • Uroflowmetry: Qmax <10 ml/sec indicates obstruction. • Retrograde Urethrogram (RUG) - Gold standard. • MCU - Posterior urethral assessment. • Urethroscopy - Direct visualization.
- 26. 11/08/2025 Professor Bhavani Rao Acuteurinary retention
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- 28. 11/08/2025 Professor Bhavani Rao Preferredtreatment for a short bulbar urethral stricture (<1.5 cm):
- 29. 11/08/2025 Professor Bhavani Rao Open Urethroplasty Goldstandard Buccal mucosa
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- 31. 11/08/2025 Professor Bhavani Rao DEFINITIVEMANAGEMENT • Dilatation - Temporary relief, high recurrence. • VIU - For short strictures, recurrence common. • Open Urethroplasty - Gold standard for long strictures. • Perineal urethrostomy - For complex/recurrent cases.
- 32. 11/08/2025 Professor Bhavani Rao FOLLOW-UP& COMPLICATIONS • Follow-up with flow rate, symptoms, imaging. • Complications: recurrent UTI, stones, hydronephrosis, Urinary fistula.
- 33. 11/08/2025 Professor Bhavani Rao SUMMARY •Early diagnosis prevents complications. • Tailor management to length, site, and recurrence. • Urethroplasty offers best long-term results.
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Editor's Notes
- #1 For MBBS Students - As per NMC Curriculum Address through web cam https://onedrive.live.com/personal/410986d2df077281/_layouts/15/Doc.aspx?resid=410986D2DF077281!seadc29dcb78c420eac9f603b94ad7f4a&cid=410986D2DF077281&migratedtospo=true&app=PowerPoint Deep dive QR code Song
- #2 “Imagine a 35-year-old man walks into your OPD with complaints of poor urinary stream and straining to pass urine for the past few months…” Urethral stricture is a fibrotic narrowing of the urethra due to scarring of the urethral epithelium and underlying spongy tissue (corpus spongiosum). • It leads to obstruction of urinary flow, recurrent infections, and sometimes upper tract damage. A hallmark clinical feature of urethral stricture is: Poor urinary flow
- #3 A young man with obstructive symptoms and a history of catheterization is more likely to have urethral stricture, whereas an elderly gentleman with poor stream and nocturia is more likely to have BPH.” “Young man → Think Stricture; Old man → Think Prostate.”
- #4 Male urethra Anatomy anterior view Bulbar part of urethra most commonly involved in strictures
- #5 Male urethra lateral view
- #7 How to Find the Female Urethral Opening (External Urethral Meatus) 1. Anatomical Location • The female external urethral opening is: • Situated in the vestibule of the vulva. • Lies just above the vaginal opening (introitus). • Located below the clitoris, approximately 2.5 cm below the clitoral glans. • Appears as a small slit or round opening.
- #9 posterior urethral valves in children
- #10 Iatrogenic: Instrumentation, catheterization, TURP The most common cause of urethral stricture in adults is:
- #11 TURP, or transurethral resection of the prostate,
- #13 Traumatic: Pelvic fracture leading to posterior urethral injury. Blood at the tip of urethra
- #14 Etiology Summary
- #15 Lower Urinary Tract Symptoms (LUTS): • Obstructive:
- #16 Irritative: • Frequency • Urgency • Dysuria 🔶 Other Clinical Clues: • Recurrent UTIs • Perineal discomfort • Spraying of urine • Urinary tract stones or secondary hydroureteronephrosis • Acute urinary retention if complete blockage
- #17 Remember the “obstructive and irritative symptoms”. A 40-year-old male has recurrent UTI and post-void dribbling. Likely diagnosis: poor stream is not a typical irritative symptom 🔶 Lower Urinary Tract Symptoms (LUTS): • Obstructive: • Poor urinary stream • Straining to void • Intermittent stream • Post-void dribbling • Incomplete emptying • Urinary retention (in severe cases) • Irritative: • Frequency • Urgency • Dysuria 🔶 Other Clinical Clues: • Recurrent UTIs • Perineal discomfort • Spraying of urine • Urinary tract stones or secondary hydroureteronephrosis • Acute urinary retention if complete blockage
- #18 Examination 🔸 General: • Look for signs of infection, fever, dehydration. 🔸 Local (Genital and Perineal Exam): • Palpate for: • Periurethral induration • Perineal scarring or fistula • Bladder distension on abdominal exam. 🔸 Digital Rectal Examination: • To rule out associated prostatitis or prostatic pathology.
- #19 Investigations Divide this into: ✅ Basic Investigations: • Urine Routine & Culture – to rule out infection. • Blood Urea, Serum Creatinine – to assess renal function.
- #20 Measures peak flow rate (Qmax <10 ml/sec is suggestive of obstruction).
- #21 Retrograde Urethrogram (RUG): • Gold standard. • Helps localize and measure the length of the stricture. • Especially useful in anterior urethral strictures.
- #22 Micturating Cystourethrogram (MCU): • Useful to study posterior urethra and bladder neck. • Shows stricture with proximal urethral dilatation.
- #23 Ultrasound KUB + Post-void Residual Urine: • Detects residual urine, bladder wall thickening, hydronephrosis. Urethroscopy (Endoscopy): • Direct visualization of the stricture. • Useful in therapeutic planning.
- #24 Ultrasound KUB + Post-void Residual Urine: • Detects residual urine, bladder wall thickening, hydronephrosis.
- #25 Summary Investigations - Specific
- #26 Acute Management: • If in urinary retention: • Suprapubic catheterization may be required if urethral catheterization fails. Treat infections with antibiotics.
- #27 Definitive Treatment Options: 1. Dilatation: • Gradual dilatation using filiforms and followers or metal sounds. • High recurrence rate. • Done as an initial/temporary measure or in poor surgical candidates.
- #28 Preferred treatment for a short bulbar urethral stricture (<1.5 cm): Visual Internal Urethrotomy (VIU): • Done under endoscopic guidance. • Suitable for short strictures <1.5 cm. • High recurrence if long segment or multiple strictures. • Recurrence rate ~30–70%.
- #29 Open Urethroplasty: • Gold standard for long/recurrent strictures. • Types: • End-to-End anastomotic urethroplasty (for short bulbar strictures). • Substitution urethroplasty using grafts (buccal mucosa) or flaps. • Low recurrence rates. • Technically demanding.
- #30 Perineal urethrostomy: • Used in complex or failed cases, often elderly patients.
- #31 Summary Definitive Management
- #32 Follow-Up • Monitor with: • Flow rate (Qmax) and PVR urine • Patient symptoms • Repeat RUG/MCU if symptoms recur 8. Complications if Untreated • Recurrent UTIs • Periurethral abscess • Urethrocutaneous fistula • Bladder stone formation • Upper tract deterioration – hydronephrosis, renal failure
- #34 Birds Upper Open urethral strictures, word document Lower deep dive Command (⌘) + F1. or Command (⌘) + Fn + F1 https://notebooklm.google.com/notebook/2206370b-3e60-4bd6-9a97-330e7e9b2d8d/audio
- #36 “The Stricture Song (Urethra Highway Blues)” 🎸 (To the tune of a classic toe-tappin’ country song) [Verse 1] Well, I woke up feelin’ funny, couldn’t pee like I used to do, That stream was weak, it sprayed a bit—felt like a leaky ol’ canoe. Went down to see my doctor, he gave me quite the news, Said “Son, it’s a stricture on your urethral route—ain’t that a funky fuse?”
- #43 https://forms.office.com/r/TRnw52WifD