lecture slide on Urethral Stricture.pptx

useful for the nurses

1. Urethral Stricture Mr Yogendra Mehta Lecturer, HOD(Adult Health Nursing) TU IOM BNC

2. Introduction The urethra is a tube that carries urine from the bladder so it can be expelled from the body. Usually the urethra is wide enough for urine to flow freely through it. When the urethra narrows, it can restrict urinary flow. This is known as a urethral stricture. Urethral stricture is a medical condition that mainly affects men

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4. Contd.... This is usually due to tissue inflammation or the presence of scar tissue. Scar tissue can be a result of many factors. Young boys who have hypospadias surgery (a procedure to correct an underdeveloped urethra) and men who have penile implants have a higher chance of developing urethral stricture

5. Causes/Risk Factors A straddle injury is a common type of trauma that can lead to urethral stricture. Examples: falling on a bicycle bar or getting hit in the area close to the scrotum. Pelvic fractures Catheter insertion Radiation Surgery performed on the prostate Benign prostatic hyperplasia

6. Contd.... Rare causes include: a tumor located in close proximity to the urethra untreated or repetitive urinary tract infections the sexually transmitted infections (STIs) gonorrhea or chlamydia

7. Clinical Features Urethral stricture can cause symptoms mild to severe. Some of the signs of a urethral stricture include: weak urine flow or reduction in the volume of urine sudden, frequent urges to urinate a feeling of incomplete bladder emptying after urination frequent starting and stopping urinary stream pain or burning during urination inability to control urination (incontinence)

8. Contd.... pain in the pelvic or lower abdominal area urethral discharge penile swelling and pain presence of blood in the semen or urine darkening of the urine inability to urinate (this is very serious and requires immediate medical attention)

9. Diagnosis History Taking Physical Examination: A simple physical examination of the penis. Observe redness (or urethral discharge) and find out if one or more areas are hard or swollen. measuring the rate of flow during urination analyzing the physical and chemical properties of urine to determine if bacteria (or blood) are present

10. Contd.... Cystoscopy : inserting a small tube with a camera into the body to view the inside of the bladder and urethra (the most direct way to check for stricture). Measuring the size of the urethral opening Tests for chlamydia and gonorrhea

11. Staging

12. Management Approaches Unsurgical Primary mode of treatment is to make the urethra wider using a medical instrument called a dilator.  Doctor will begin by passing a small wire through the urethra and into the bladder to begin to dilate it. Over time, larger dilators will gradually increase the width of the urethra. Another nonsurgical option is permanent urinary catheter placement. This procedure is usually done in severe cases. It has risks, such as bladder irritation and urinary tract infection.

13. Contd.... Surgery Open urethroplasty is an option for longer, more severe strictures. This procedure involves removing affected tissue and reconstructing the urethra. Results vary based on stricture size. Internal Urethrotomy Urethroplasty

14. Contd.... Internal Urethrotomy  Surgeon will first insert a scope into the urethra so they can see the stricture. Then, they’ll use a small, sharp surgical instrument, called an endoscopic scalpel, to cut the stricture open. They’ll do this in one or two places to increase the diameter of your urethra. 

15. Contd.... Urethroplasty Primary anastomotic urethroplasty surgeon will cut out the diseased section that’s causing the stricture and reattach the healthy ends. They’ll usually perform this procedure for short segment strictures.

16. Contd.... Incision and grafting, or ventral onlay grafting Urethroplasty is generally reserved for longer segments of stricture. In this procedure, your surgeon will cut open the stricture on the bottom side. Then, they’ll use a piece of tissue to enlarge the diameter of the urethra. The tissue usually comes from the inner cheek, called the buccal mucosa.

17. Urethroplasty

18. Contd.... Urine flow diversion Complete urinary diversion This surgery permanently reroutes the flow of urine to an opening in the abdomen. It involves using part of the intestines to help connect the ureters to the opening. Urinary diversion is usually only performed if the bladder is severely damaged or if it needs to be removed.

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20. Pre/Post Nursing Care Provide routine preoperative care. Assess knowledge of the proposed surgery and its long-term implications, clarifying misunderstandings and discussing concerns. Begin teaching about postoperative tubes and drains, self care of stoma, and control of drainage and odor . Assist in identifying stoma site, avoiding folds of skin, bones, scar tissue, and the waistline or belt area. Be sure to consider the client’s occupation and style of clothing. Assess size, color , and condition of the stoma and surrounding  skin every 2 hours for the first 24 hours, then every 4 hours for 48 to 72 hours .

21. Contd.... The site should be visible to the client and accessible for manipulation. Care is taken to place the stoma away from areas of constant irritation by clothing or movement. It should be located so that the client can cover and disguise the collecting device, maintain the seal to prevent leakage, and effectively cleanse and maintain the site. Monitor intake and output carefully, assessing urine output every hour for the first 24 hours, then every 4 hours or as ordered. Call the physician if urine output is less than 30 mL per hour. Tissue edema and bleeding may interfere with urinary output from stoma, catheters, or drains. Maintenance of urine out

22. Contd.... flow is vital to prevent hydronephrosis and possible renal damage. A urine output of at least 30 mL per hour is necessary for effective renal function. Assess color and consistency of urine. Expect pink or bright red urine fading to pink and then clearing by the third postoperative day. Urine may be cloudy due to mucus production by bowel mucosa. Bright red blood in the urine from a urinary diversion may indicate hemorrhag .,

23. Contd.... Expect the stoma to appear bright red and slightly edematous initially. Slight bleeding during cleansing is normal. Irrigate the ileal diversion catheter with 30 to 60 mL of normal saline every 4 hours or as ordered. Mucus produced by the bowel wall may accumulate in the newly devised reservoir or obstruct catheters. Monitor serum electrolyte values, acid-base balance, and renal function tests such as BUN and serum creatinine . Teach the client and family about stoma and urinary diversion care, including odor management, skin care, increased fluid intake, pouch application and leakage prevention, self-catheterization for clients with continent reservoirs, and signs of infection and other complications.