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urethral stricture
structure of the urethra
Etiology:
- sexually-transmitted disease
- urethral catheterization
- cystoscopy
- indwelling urinary catheter (Foley catheter)
- benign prostatitic hypertrophy (BPH)
- pelic trauma
- recurrent urethritis
Epidemiology:
- congenital urethral strictures are rare
- urethral strictures in women are rare
Clinical manifestations:
- blood in the semen
- bloody or dark urine
- oliguria
- urinary hesitancy or inability to urinate
- urethral discharge
- urinary frequencyInability to urinate
- urinary incontinence
- dysuria
- pelvic pain, abdominal pain
- slow urine stream
- edema of the penis
- distended bladder
- inguinal lymphadenopathy
- enlarged prostate
- physical exam may be normal
Laboratory:
- urinalysis with urine culture if indicated
- Genprobe for chlamydia & gonorrhea
Special laboratory:
- cystoscopy
- post-void residual volume (PVR)
- retrograde urethrogram
- urinary flow rate
Complications:
- urinary retention
Management:
- suprapubic catheter may necessary to alleviate urinary retention if a catheter cannot be passed through the urethra
- urethra may be widened (dilated) during cystoscopy
- open urethroplasty may be done for longer strictures
- if all else fails, a urinary diversion - appendicovesicostomy (Mitrofanoff procedure) - may be done; this allows self-catheterization of the bladder through the wall of the abdomen
- self catheterization may help to maintain urethral patency
- prognosis: repeated treatment may be needed to remove scar tissue
Related
urethra
General
urethral disorder
stricture
postrenal azotemia; obstructive uropathy
References
- MedlinePlus: Urethral stricture
http://www.nlm.nih.gov/medlineplus/ency/article/001271.htm
- Google Health: Urethral stricture
https://health.google.com/health/ref/Urethral+stricture
- Mayo Clinic: Urethral stricture
http://www.mayoclinic.org/urethral-stricture/
- The Center for Reconstructive Urology: Urethral Stricture
http://www.centerforreconstructiveurology.org/urethralstricture/