URETHRAL STRICTURE AND URETHRITIS full.pptx

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2. CLASS PRESENTATION ON URETHRAL STRICTURE AND URETHRITIS By RISHITA DEY Roll No.- 28 4 th Semester B.Sc Nursing student College of Nursing , ESI Hospital , Asansol

3. GENERAL OBJECTIVES After completion of the topic, the group will be able to :- Gain knowledge about Urethritis and Urethral Stricture. Develop positive attitude towards obstruction of urinary passage. Develop skills regarding management of patients with Urethritis and U rethral Stricture .

4. INTRODUCTION The human urinary system intricate in its design and functionality, plays a vital role in maintaining physiological balance . Within this system, the urethra serves as a crucial conduit for the expulsion of urine from the bladder. However despite its importance, the urethra is vulnerable to various ailments , two of which stand out prominently : URETHRAL STRICTURE and URETHRITIS.

5. URETHRAL STRICTURE - DEFINITION The Urethral Stricture refers to anterior urethral disease or a scarring process involving the spongy erectile tissue of corpus spongiofibrosis . Urethral stricture is characterized by a narrowing of the urethral lumen , causing functional obstruction. Most common cause of Urethral stricture is u retero pelvic junction (UPJ) Obstruction, which is characterized by a congenital or acquired narrowing at the level or UPJ.

6. INCIDENCE In the United States, the incidence of Urethral Stricture has been estimated to be around 0.6-0.9 cases per 1000 males per year. This incidence tends to increase with age, more common in people with history of sexually transmitted infections or in patients with catheterization. The worldwide incidence of Urethral Stricture varies across different regions and populations. In India, the incidence may be higher due to population density , hygiene practices , and prevalence of sexually transmitted infections.

7. ANATOMY AND PHYSIOLOGY ANATOMY OF THE RENAL SYSTEM :- The Renal System , also known as the Urinary system, consists of the following organs that work together to produce , store and eliminate urine from the body, they are :- 1. KIDNEYS :- Paired organs located in the posterior part of the abdominal cavity, one on each side of the spine. The kidneys filter blood to remove waste products and excess substances , producing urine. 2. URETERS :- Narrow tubes that connect each kidney to the bladder. They transport urine from the kidneys to the bladder using peristaltic contractions. 3. BLADDER :- A hollow, muscular organ located in the pelvis. Stores urine until it is expelled from the body. 4. URETHRA :- A tube that connects the bladder to the outside of the body. Allows urine to pass from bladder to the exterior during urination. 5. RENAL PELVIS :- A funnel shaped structure in the kidney that collects urine before it passes into the ureter. 6. RENAL CORTEX AND MEDULLA :- Regions within the kidney where different stages of urine production occurs.

8. ANATOMY OF URETHRA :- The urethra is a tube-like structure that carries urine from the bladder to the outside of the body during urination. In males, it also serves as the passage of semen during ejaculation. In males, the urethra is longer and passes through the prostate gland and penis. It is divided into 3 parts :- 1. Prostatic urethra 2. Membranous urethra 3. Penile urethra In females, the urethra is shorter and located between the clitoris and the vaginal opening. Both males and female urethras have similar structures, including mucous membranes, smooth muscle layers and epithelial linings.

9. PHYSIOLOGY OF URETHRA :- The physiology of the urethra involves several key functions :- 1. Urinary Flow Control 2. Sphincter Function 3. Ejaculation 4. Mucosal Lubrication 5. Sensation

10. TYPES OF URETHRAL STRICTURE A. Based on their location within the urethra : Anterior Urethral Stricture – Occurs in the portion of urethra that runs through the penis . Further classified into : 2) Meatal Stricture – Narrowing at the opening of urethra meatus. 3) Bulbar Stricture – Narrowing in the bulbar segment of the urethra, portion that passes through the bulb of penis. 4) Penile Urethra – Narrowing in the penile segment of the urethra , which is the portion that passes from the bulb to the tip of the penis. Posterior Urethral stricture – Occurs in the portion of the urethra that runs through the prostate gland and the pelvic floor muscles. Further classified into : 1 ) Membranous Stricture – Narrowing in the membranous segment of the urethra. 2) P rostatic Stricture – Narrowing in the prostatic segment of the urethra, which extend from the bladder neck to the membranous urethra. B. Based on their Cause or Etiology : 1) Inflammatory Stricture – Results from inflammatory conditions such as urethritis, sexually transmitted infections. 2) Traumatic Strictures – Trauma to the urethra often from catheterization, pelvic fracture. 3) Iatrogenic Strictures – Occurs as a complication of Medical procedures involving urethral surgery. 4 ) Congenital Strictures – Some individuals are born with narrow urethra , predisposing them to the development of strictures later in life. 5) Idiopathic Strictures – In some cases the cases of the stricture is unknown termed as idiopathic.

11. ETIOLOGY AND RISK FACTORS Pelvic fractures After passage of kidney stone or as a result of certain cancer. In children congenital abnormalities may result in strictures. External traumatic injuries Pelvic radiation therapy Urinary diversion surgery Catheter insertion Benign prostatic hyperplasia

12. PATHOPHYSIOLOGY Pathological analysis of the stricture reveals Disordered collagen deposition , fibrosis and varying levels of inflammation Resulting urethral obstruction may vary mild to severe Which causes complete obstruction and subsequent loss of renal function.

13. CLINICAL MANIFESTATIONS Blood in the semen. Bloody or dark urine. Decreased urine output Difficulty urinating Discharge from the urethra. Frequency or urgent urination. Pain in lower abdomen, pelvic pain. Urinary incontinence.

14. DIAGNOSTIC EVALUATION History collection related to symptoms of urethral stricture Physical examination significant signs to urethral stricture Urinalysis Urine culture test Serum electrolyte with serum blood urea nitrogen and creatinine to study the status of the kidney function. Ureteroscopy Renal ultrasonography Intravenous pyelography Computed tomography

15. MANAGEMENT GOAL – To reduce pain and discomfort , prevent complications, and relax the muscles around the urethra. A. PHARMACOLOGICAL MANAGEMENT Alpha Blockers :- First drug of choice, that help relax the muscles of the urethra, making it easier to pass urine and reducing symptoms such as hesistancy , weak stream and incomplete emptying. a ) Tamsulosin b ) Terazosin Non Steroidal Anti Inflammatory Drugs (NSAIDs) :- Help reduce inflammation and alleviate pain associated with urethral stricture. A) Ibuprofen B) Naproxen Antibiotics – To prevent or treat bacterial infections, or increased risk of infections due to urinary retention. A) Ciprofloxacin B) Levofloxacin Pain relievers – To manage discomfort and pain caused by urethral stricture. A) Acetaminophen B) Cyclobenzaprine ( Flexeril ). Anticholinergics - To manage symptoms such as urinary urgency, frequency, or bladder spasms. A) Oxybutynin B) Tolterodine (Detrol).

16. B .NON PHARMACOLOGICAL MANAGEMENT Hygiene and Lifestyle modifications. Nutritional and Dietary Considerations. Pelvic Floor Exercises – Kegel Exercises may help improve bladder control and urinary function.

17. SURGICAL MANAGEMENT 1. Urethral Dilation – Involves inserting a series of progressively larger instruments into the urethra to stretch or dilate the narrowed areas. Effect is temporary and repeated dilations may be necessary. 2. Balloon Dilation – Stricture is dilated using dilator by gradual stretching the tissues. It is followed by stent placement for 4 to 6 weeks. 3. Endoureterotomy – is to open a stricture in a ureter . Urethral incisions can be performed with an endoscopic cold knife. 4 . Transureteroureterostomy (TUU)- In severe or complex urethral stricture cases , extensive reconstruction of the urethra is necessary. In this technique which is used to join one ureter to the other across the midline. It is also used in un diversion procedures where the surgeon wants to avoid the pelvis because of previous trauma, surgery , radiation therapy. 5 . Urethrotomy – A urologist uses a small knife or laser to cut through the narrowed portion of the urethra allowing for improved urine flow. 6 . Urethral Stent Placement – A urologist may insert a stent into the urethra to keep it open and allow urine to pass freely. Complications such as tissue irritation are associated so this method is temporary or in patients not suitable for other surgical interventions. 7. Ureteroneocystostomy – Re implantation of the ureter into the bladder.

18. NURSING MANAGEMENT Check body temperature , and provide nursing care to prevent hyperthermia. Check level of pain Administer prescribed analgesics. Post surgery antibiotics will be given to prevent infections. IV fluids will be administered to maintain fluid-electrolyte balance. If patient has indwelling catheter- A) monitor urine output . B) ensure catheter is patent and draining urine. C) do perineal care and catheter care. In case of patient with undergone for surgery : A) monitor urine output B) monitor vital signs C) monitor patient for signs of infection D) check color of urinary drainage E) maintain fluid and electrolyte balance. F) relief anxiety and provide psychological support .

19. COMPLICATIONS > Urine leakage from the ureter or bladder. >Stricture returning after surgery. >Kidney damage. >Blood clots.

20. URETHRITIS - DEFINITION Urethritis is the inflammation of the urethra , the tube that carries urine from the bladder out of the body. It is often caused by a bacterial or viral infection and can lead to symptoms like painful urination , discharge, and discomfort in the genital area. Urethritis usually resolves without complications , even if untreated yet ,it can result in urethral stricture, stenosis, abscess formation in rare cases.

21. INCIDENCE Urethritis is predominantly a disease of adolescents, and adult men. The prevalence is greater in men younger than 25 years . It affects people of all ages. Both males and females can develop this condition. However, females have a greater chance of developing this condition than males.

22. TYPES A) Based on the source of infection 1 . Infectious Urethritis – Caused by bacteria, virus or other infectious agents. Common pathogens includes Neisseria gonorrhoea , Chlamydia trachomatis, Mycoplasma genitalium . 2. Non Infectious Urethritis – Caused by irritants or other non infectious factors such as soaps, spermicides, trauma to the urethra, or autoimmune condition affecting the urethra. B) Based on type of bacteria causing the infection 1. Gonococcal Urethritis – Caused by the bacterium Neisseria gonorrhoea , typically transmitted through sexual contact. Requires specific antibiotic treatment. 2 . Non Gonococcal Urethritis – Not caused by Neisseria gonorrhoea . It is often caused by other sexually transmitted infectious pathogens such as Chlamydia trachomatis, Mycoplasma genitalium or Trichomonas vaginalis . C) Based on the duration of the disease 1 . Acute Urethritis – Sudden onset of symptoms, often associated with recent exposure to an infectious agent or irritant. 2. Chronic Urethritis – Lasting for more than six weeks. May result from recurrent infections, underlying health conditions.

23. COMPARISON BETWEEN GONOCOCCAL AND NON GONOCOCCAL URETHRITIS GONOCOCCAL URETHRITIS Infection of urethra caused by gonorrhoea bacteria . Caused by gonococcal bacteria – Neisseria gonorrhoea . Incubation period 2-5 days Onset of symptoms is abrupt. Intense burning sensation while passing urine. Discharge is profuse and yellowish green. Fever and malaise more commonly seen. NON GONOCOCCAL URETHRITIS Infection of urethra not caused by gonorrhea bacteria. Caused by other infectious agents- 1. Chlamydia trachomatis 2. Mycoplasma genitalium 3. Trichomonas vaginalis Incubation period 2 -3 weeks. Onset of symptoms is less severe. Patients usually have a smarting feeling while passing urine. Discharge is usually mucoid / mucopurulent . Fever and malaise are less commonly seen.

24. ETIOLOGY AND RISK FACTORS Commonly caused by gonococcal or non gonococcal bacteria, most notably C.trachomatis , N.gonorrhea , and M.genitalium . Infectious causes may be related to sexually transmitted gonococci or chlamydia infections. Irritation from chemical irritants such as soaps, spermicides. Trauma or injury to the urethra which can occur during sexual activity or catheterization. Autoimmune conditions such as Behcet’s disease.

25. RISK FACTORS Female gender of reproductive age. More common in young males. Unprotected sexual practices. Multiple sexual partners.

26. PATHOPHYSIOLOGY Urinary tract infections , Foreign body in urethra, Chemical irritants Irritation and inflammation of urethra Urethritis Yellow discharge Dysuria

27. CLINICAL MANIFESTATIONS Burning on urination. Frequent urination with only small amounts of urine passed on each occasion . Bloody discharge from the penis. Blood in the urine/ semen in males. Yellow discharge from the urethra. Purulent , cloudy, blood tinged urethral discharge.

28. DIAGNOSTIC EVALUATION History collection related to urethritis symptoms. Inspect the underwear for secretions. Penis examination retract the foreskin to assess for any lesions indicates STDs. Urine culture Urethral examination. Urethral smear microscopic examination. Urine analysis. Cystoscopy

29. MEDICAL MANAGEMENT PHARMACOLOGICAL MANAGEMENT Antibiotics – Commonly prescribed antibiotics for the treatment of urethritis are : 1 . Azithromycin – Often prescribed as a single dose., it is effective against Chlamydia trichomatis , which is the common cause of urethritis. 2 . Doxycycline – Taken orally for a course of 7 days, it is effective against Chlamydia trichomatis and Mycoplasma genitalium . 3. Ceftriaxone – Administer as an injection, it is often used in combination with Azithromycin for the treatment of gonococcal urethritis caused by Neisseria gonorrhoae . 4. Cefexime – An oral antibiotic , alternative to ceftriaxone for gonococcal treatment, becoming less common due to increasing antibiotic resistance. Pain relievers – Non steroidal anti-inflammatory drugs such as Ibuprofen, can help reduce pain and inflammation. Acetaminophen – Can be used if NSAID s are not suitable.

30. NON PHARMACOLOGICAL MANAGEMENT Drink plenty of fluids can help flush out the urinary tract and reduce discomfort during urination. Avoiding alcohol, caffeine, spicy foods , and acidic beverages. Applying a warm, damp cloth to genital area can reduce discomfort. Taking adequate rest and avoiding sexual activities can allow the body to heal. Maintaining good hygiene , including gentle washing of the genital area with mild soap water can prevent irritation and infection.

31. SURGICAL MANAGEMENT Urethral Dilation – Stretching the urethra to widen it, can improve urine flow and reduce symptoms of urethritis. Urethrotomy – It is done to incise the scar tissue and widen the urethra. Urethroplasty – Involves reconstructing a portion of the urethra using tissue grafts from other parts of the body. Transurethral Resection of the Prostate – In cases where urethritis is caused by Benign prostatic hyperplasia, it is performed to remove excess prostate tissue.

32. NURSING MANAGEMENT Check vital signs of patient. Ask patients about associated symptoms. Encourage patients to drink plenty of water. Maintain perineal hygiene. Monitor urine color and consistency. Encourage patients to take antibiotics as per doctor’s advice. Instruct patients to wear cotton underwear and change it twice until infection subsides.

33. COMPLICATIONS Recurrent infections Sexual complications Urethral strictures or stenosis Prostatitis Cystitis Increased risk of HIV transmission Infertility

34. NURSING DIAGNOSIS 1 . Impaired urinary elimination related to frequent urination as evidenced by urinary frequency, frequent urge to urinate. 2. Infection related to urinary retention as evidenced by burning sensation with urination , supra pubic tenderness. 3. Acute pain in lower abdomen related to inflammation and infection of the urethra as evidenced by burning on urination, facial grimaces. 4 . Hyperthermia related to inflammation as evidenced by increased body temperature above normal range. 5 . Deficient knowledge related to disease and management of UTI as evidenced by lack of information, multiple questionnaires. 6. Disturbed sleep pattern related to pain as evidenced by restlessness, irritability.

35. DIET PATTERN Drink plenty of water Limit or avoid spicy foods like caffeine, alcohol and acidic foods. Increased plenty of fiber rich foods like fruits, vegetables , whole grains , and legumes. Eat lean sources such as poultry, fish , tofu instead of fatty meals. Eat probiotics rich foods such as Yogurt to promote healthy balance of bacteria in gut ,reduce risk of UTIs.

36. HEALTH TEACHING Explain patient about Urethritis and Urethral stricture including causes, symptoms and management. Educate the patient on how to recognize symptoms such as painful urination, difficulty urinating. Ensure the purpose of each medication, its purposes and potential side effects. Educate about sexual hygiene, such as safe sex , sexual partners, use of condom during intercourse. Get medical test regularly. Drink plenty of fluids and make sure to urinate shortly after intercourse.

37. PROGNOSIS The prognosis for Urethral stricture and Urethritis depends on various factors such as the underlying cause , severity , treatment approach and individual health. With prompt and appropriate treatment , many cases of Urethritis can be resolved without complications. Prognosis can also vary based on how well a person adheres to treatment recommendations, and manages any underlying conditions.

38. CONCLUSION Urethral stricture and Urethritis can have significant impacts on Urinary function and quality of life if left untreated or poorly managed. Overall, with timely medical intervention, adherence to treatment regimens, regular follow-up care, many individuals with Urethritis and Urethral stricture can experience symptom relief and a good prognosis.

39. SUMMARISATION

40. SUMMARISATION

41. QUESTIONS ASKED IN PAST 10 YEARS

42. BIBLIOGRAPHY Lewis’s Medical – Surgical Nursing Book . Textbook of Medical-Surgical Nursing ( Wolters India Pvt. Ltd.) Medical Surgical Nursing I and II ( Jaypee Brothers Medical Publishers). Adult Health Nursing – II ( Jaypee Brothers Medical Publishers).

43. THANK YOU