urethral stricture

Urethral stricturedr.mohamed fawzi alshahwani

causis Inflammatory post gonorrhealCongenitalTraumaticInstrumental indwelling catheter urethral endoscopyPost operative open prostatectomy amputation of penis

Clinical features Obstructive symptoms straining, weak stream, terminal dribbling, & in severe cases retention of urineIrritative symptoms increasing frequency day and night due to incomplete evacuation or infection

diagnosis History of infection,trauma,folleys catheter or endoscopy obstructive symptomsUroflowmetryUrethrographyurethroscopy

Complication Retention of urineUrethral diverticulumPeriurethral abscessUrethral fistulaHernia,hemorrhoids,rectal prolaps due to straining during voiding

Treatment Urethral dilatation metal dilators (sounds) Filiforms&followersEndoscopic incision by cold knife or laser it seem to cure 50% of simple stricture may be supplemented by intermittent dilatation to improve success rate infection and bleeding are rare comlication


Urethroplasty Should be considered when more simple means fail to give lasting relief of symptoms Short stricture……excision with end to end anastomosis other wise different types of flaps or graft uses for more complicated stricture

Urinary diversiondr,mohamed fawzi alshahwani

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Urinary diversion

Temporary to relieve distal obstructionPermanent after removal of the bladder

Urinary diversion

Temporary (for bladder obstruction) indwilling silicone urethral foley catheter suprapubic cystostomy (for long time) major problem is infection

Urinary diversion

Temporary(for the obstructed kidney) Double j pigtail ureteric stent (change every three monthes) nephrostomy (if jj not possible) percutaneous formal

Double j stent

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Urinary divertion

Permanent divertion External ileal conduit (external stoma)/incontenent continent urinary divertion Internal divertion ureterosigmoidostomy neobladder


Urinary diversion .Indications of permenent divertion: 1- After simple or radical cystectomy.2- severe neuropathic bladder dysfunction.3- uncorrectable urinary fistula .4- severe intractable interstitial cystitis .5- prior to renal transplantation in patient with lower tract dysfunction. *

Ileal conduitpermenent,external,incontenent

Continent urinary divertionexternal,permenent



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Neobladder internal ,permenent,contenent

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ilial pouch *

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Complications:1- stoma and skin problems.2- metabolic complications.3- recurrent UTIs.4- uretero-intestinal anastomotic stricture.5- colonic carcinoma.6- osteomalacia. *