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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Urethral strictures occur in the background of chronic inflammation or after urethral trauma. If present in the anterior urethra, they may cause fibrosis of the corpus spongiosum, although they may affect any part of the urethra. Narrowing results from collagenous scar tissue formation in response to trauma, infection or inflammation. Lichen sclerosus et atrophiais causes dermal sclerosis and usually affects the distal urethra and urethral meatus. Symptoms include urgency, frequency, initial haematuria, incontinence or recurrent UTIs. They may be noticed incidentally when attempting urethral catheterisation for another reason. Diagnosis can be made at cystoscopy, or using radiological investigations such as uroflowmetry or voiding cystourethrogram. Many surgical interventions yield a high rate of recurrence, such as internal urethrotomy, and despite all of the treatments listed above, some patients end up requiring a suprapubic catheter.
Complications of Prostate Brachytherapy: Cause, Prevention, and Treatment
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Larissa J. Lee, Anthony L. Zietman
The incidence of brachytherapy-related urethral stricture is reported to be between 0% and 12%, and has been correlated with the dose to the bulbo-membranous urethra (21). Patients with urethral stricture may present with obstructive symptoms such as weak stream or straining while voiding. The first step in management of a urethral stricture is urethral dilation or internal urethrotomy. Rarely, conversion to a suprapubic catheter or self-catheterization is required for recurrent strictures. The median time to development of a urethral stricture is approximately 24 months, but can occur many years after brachytherapy.
The patient with acute renal problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Patients may present with difficulties in voiding urine, owing to lower urinary tract obstruction. They can present with acute urinary retention, requiring immediate catheterisation (possibly suprapubic) and then diagnosis of the cause. The common reasons for this problem include: In men, prostatic hypertrophy of benign or malignant origin. The passage of urine is impaired as the urethra passes through an inflamed or enlarged prostate gland.In women, organ prolapse. The uterus can herniate through the vaginal canal, so severely in some cases that it is visible on inspection of the external genitalia. A cystocele (when a portion of the bladder wall descends into the vaginal canal) or a rectocele (where the rectum bulges into the vaginal canal) can also develop and these disorders nearly always occur secondary to childbirth, although it is not usually until the menopause that they become evident.In men or women, urethral stricture may occur secondary to infection or trauma.In men and women, tumours of the renal tract may occur and these tend to affect individuals in the fifth and sixth decades of life. Common symptoms include haematuria, pain in the affected area and sometimes a swelling of tissue. Kidney tumours are usually malignant in origin, metastasise early and often lead to urinary obstruction, with hydronephrosis. Bladder cancers are also common, but, with early intervention, the prognosis is better than for kidney tumours. The development of bladder carcinoma is strongly linked to smoking and exposure to industrial chemicals. Aromatic amines, found in paints, dyes and other substances of a similar nature, have all been linked with the occurrence of the disease (Tortora et al. 2017).
Non-transecting urethroplasty in patients with bulbar urethral strictures shorter than three centimeters
Published in Scandinavian Journal of Urology, 2023
Muhammet Şahin Yılmaz, Alihan Kokurcan, Fahrettin Şamil Uysal, Görkem Özenç, Fatih Yalçınkaya
It is known that transection of the urethra may facilitate complete excision of the scar; however, it can also lead to neurogenic urinary dysfunction and sexual dysfunction due to vascular and neural injuries [20]. On the other hand, non-transecting approaches preserve the neurovascular structures, but they may not achieve complete excision of the scar tissue [20]. It is known that complete transection of the urethra is mandatory for the excision of the traumatic scar tissue. However, it is questionable whether it is mandatory to transect the urethra to excise the scar tissue in cases with 1-2 cm, thick and narrow bulbar urethral strictures. To our knowledge, no studies showed that stricture should be excised for avoiding recurrence in patients with non-traumatic bulbar urethral strictures.
Comparison of closure versus non-closure of the intraoral buccal mucosa graft site in urethroplasties. A systematic review and meta-analysis
Published in Arab Journal of Urology, 2023
Urethral stricture is a frequently observed disease, especially in elderly men [1]. The main etiology is blamed on infections, idiopathic causes, trauma and previous urethral operations [2]. For treatment of urethral stricture, optical urethrotomy interni is the most commonly used method. However, urethral stricture disease may recur, although this is more common with infectious causes, complicated and long urethral strictures [3]. The gold standard surgery for treatment of recurrent stricture is urethroplasty [4]. The male urethral stricture guidelines of the American Urological Association (AUA) recommend urethroplasty for recurrent and complicated stricture of the meatus and fossa, all stricture in the penile urethra and recurrent strictures longer than > 2 cm in the bulbar urethra [5].
Urethral stricture and scrotal abscess: a rare case presentation of penile cancer and review of the literature
Published in The Aging Male, 2020
Aldo Franco De Rose, Francesca Ambrosini, Laura Tomasello, Francesco Boccardo, Carlo Terrone
A 67-year-old male presented to the Department of Urology, San Martino Hospital (Genova) in December 2017 with high temperature and purulent urethral discharge. He was cigarette smoker and suffered from chronic obstructive pulmonary disease, but apart from that the patient’s medical history was unremarkable. The patient did not provide any history of urethral trauma or sexually transmitted disease. In July 2017, a suprapubic cystostomy had been placed for the management of obstructive voiding symptoms, after failed urethral catheterization in another Department. A urethral stricture had been suspected. In September 2017, the patient had been admitted because of penoscrotal abscess extending to surrounding subcutaneous tissue. A perineal urethrostomy had been performed after several unsuccessful attempts of conservative treatment. A malignant disease was not rule out.