This document discusses urethral strictures, which are characterized by a narrowing of the urethral lumen causing obstruction. Common causes include ureteropelvic junction obstruction, pelvic radiation therapy, urinary diversion surgery, traumatic injuries, congenital anomalies, kidney stones, cancers, and infections. Symptoms include blood in urine or semen, painful urination, and decreased urine flow. Diagnosis involves examinations, urinalysis, imaging tests. Treatment options include balloon dilation, endoureterotomy, ureteral stents, transureteroureterostomy, and ureteroneocystostomy.
3. A urethral stricture is characterized by a narrowing of
the urethral lumen, causing functional obstruction.
Most common cause of urethral stricture is
ureteropelvic junction (UPJ) obstruction, which is
characterized by a congenital or acquired narrowing
at the level of UPJ.
4. After treatment for another urological condition,
pelvic radiation therapy or urinary diversion surgery
may develop ureteral stricture.
External traumatic injury can cause strictures.
In children, congenital anomalies may result in
strictures.
It may occur after passage of kidney stones or as
result of certain cancers.
pelvic fractures
5. catheter insertion
radiation
surgery performed on the prostate
benign prostatic hyperplasia
a tumor located in close proximity to the urethra
untreated or repetitive urinary tract infections
the sexually transmitted infections (STIs) gonorrhea
or chlamydia.
6. 1) Iatrogenic: such as those caused by catheterization,
instrumentation, and prior hypospadias repair.
2) Infectious or inflammatory: caused by
gonorrhoea or lichen sclerosis.
3) Traumatic stricture: including
straddle injuries or pelvic fractures
7. Pathological analysis of the stricture reveals
Disordered collagen deposition, fibrosis and varying
level of inflammation
The resulting urethral obstruction may vary widely
from mild to severe
Which cause complete obstruction and subsequent loss
of renal function
8. Blood in the semen
Bloody or dark urine
Decreased urine output
Decreased urinary stream
Difficulty urinating
Discharge from the urethra
Frequent or urgent urination
Urinary retention
Distended (enlarge) bladder
9. Incontinence
Painful urination (dysuria)
Pain in the lower abdomen
Pelvic pain
Slow urine stream
Spraying of urine stream
Enlarged or tender lymph nodes in the groin area
Enlarged or tender prostate
Hardness on the under surface of the penis
Redness or swelling of the penis
10. A detailed patient history and physical examination
Urinalysis
Urine culture and sensitivities
Serum electrolyte with serum blood urea nitrogen and
creatinine
Ureteroscopy
Renal ultrasonography
Computed tomography
Interavenous pyelography
Retrograde pyelography
Nuclear medicine diuretic scan
12. 1) Balloon dilation:
Followed by stent placement for 4-6 weeks.
2) Endoureterotomy:
Is to open a stricture in a ureter.
Ureteral incisions can be performed with an
endoscopic cold knife.
3) Ureteral metal stents:
it have been used to treat end stage malignant
disease, provide proximal decompression.
13. It is a urinary reconstruction technique that is used to
join one ureter to the other across the midline.
TUU is also used in undiversion procedures when the
surgeon wants to avoid the pelvis because or previous
trauma, surgery or radiation therapy.