the urethra

THE URETHRA

DR. HUSSEIN LAFTA

CONGENTAL ANOMALIES

Meatal stenosis:Clinical features—showering or biforcation of urinary stream.On exam.—pinpoint opening.Complications—increase back preasure, leading to hydroureter and hydronephrosis.Treatment: -Dilatation -meatatomy -meatoplasty.

MEATOPLASTY

AMPUTATED PENIS

POSTERIOR URETHRAL VALVE

Abnormal congental mucosal fold at the prostatic urethra that look like thin membrane that impaire bladder drainge . cl. Features: -reccurent u.t.i -in sever and delay cases ,the baby presented with features of impairment of renal function due to back pressure and high grade reflux of urine from bladder back to the kid.

DIAGNOSIS

-voiding cystogram ----dilated and balooning of the prostatic urethra ,high bladder neck,trabculated bladder ,high grade reflux. -cystourethroscope. Treatment: Drainge of the bladder through suprapubic cathter or transurethral catheter. Treatment of infection. Correction of electrolite abnormalities eg acidosis and hyperkaleamia. When the condtion of the baby become stable ,then ablation of the valve by transurethral resection.

HYPOSPADIUS

Here the external urethral meatus is placed on the venteral aspect of the penis with venteral curveture of the penis{cordee}

HYPOSPADIUS

TYPES
-glandular h.:meatus is at the under surface of the glans. -coronal h.: meatus is situated at the junction of the under surface of the glans with the body of the penis. -penile h:meatus open at the venteral aspect of the shaft the penis. -penoscrotal h. -perneal h.:the scrotum is split and the urethra open between the two halves.

TREATMENT

Stage I—straightening of the penis or correction cordee by releasing the teathering and fiberosis that causes curveture of the penis-stage II:reconstriction of the urethra by forming neourethra from the prepuce or penile skin.

EPISPADIUS

The meatus is situated any where at the dorsum of the penis with dorsal curveture of the penis. Types -glandular -penile. -total usually asso. With ectopia vesicae

INJURIES OF THE URETHERA

A-complete inj. B-incomplete or partial inj. I-Inj. To the bulber urethra{ant. Urethra} Cause fall asteride aprojecting object{loose manhole cover} Cl .f. -urethral heamorrhage ------drops of blood on the external meatus. -perineal heamatoma . -retention of urine .

URTHRAL INJURY

TREATMENT

The patient is asked not to pass urine to make suprapubic cystostomy easier. -avoid plcement of foley catheter through the urethra bec. This might change partial inj. To complete one -after 10-14 days do urethrogram ;if there is stricture then do urethroscope i-if you see stricture then do optical urethrotomy . ii-if there is complete block in the urethra then do urethroplasty {removal of the scarred area with end to end anastomosis}

II-RUPTURE OF MEMBRANOUS URETHRA

This is usually occure near the apex the prostate . Causes : -fracture of the pelvis. -dislocation the symphysis pubis. -pentrating wounds of the perineum . -during cystoscope.

URETHRAL INJURY

CLINICAL FEATURES
-shock with sign of fracture of the pelvis . -swellening in the perivescal space due to collection of blood and urine . -few drops of bloods leaks through the urethra with retention of urine . -D.R.E ---displacement of the bladder backword due to tearing of pubo-prostatic ligment .

TRATMENT

-suprapubic cystostomy. -10-14days later do urethrogram : a-if patent -----nothing more . b-if stricture ------optical urethrotomy c-complete block--------urethroplasty. Note :immediate rail road technique is not preferable because it is associated with high risk of complication eg stricture ,incontenence,and impotence.

INFLAMMATION OF THE URETHRA

i-meatal ulcer : -common in circumscised boys. -due to lack of protection by prepuce which lead to friction and ammonical dermititis. Treatment: Lubrication +alkalization of urine.

II- URITHRITIS:

a- gonococcal u. b- non-gonococcal u. c- Reiter disease.

G.C. U

-It is sexual transmitted disease. -site of infection: ant. Urethra in male ,urethra and cervix in female,oropharynx,rectum ., anal canal in both sex. cl.features: Urethral discharge+sever dysurea

DIAGNOSIS

Hx of sexual contact.-Ex.—mucopurulent discharge-Ix.---direct smear reveal g-ve diplococci.

TREATMENT

High dose and short duration eg 3rdgenertion cephalosporin,ciprofloxacine, penicillin Complication : Post.Urithritis,prostatitis,epididymo-orchitis,periurethral abcess,urethral stricture.

NON-G.C URETHRITIS

Causative organism: Chlamydia trachomitis---40% Ureaplasma urealytica-----10% Unknown organism----50% cl. Feature: Mucopurulent discharge+sever dysura. Tratment-----doxacycline 100mg twice daily for 10 days.

URETHRAL STRICTURE

Causes of urethral stricture -inflammatory -----post- gonrrhoeal{mostly involve bulbar urethra} -congenital. -Trauma. -instrumental: indwelling catheter., urethroscope. -postoperative: open prostectomy., amputation of the penis.


URETHRAL STRICTURE
Clinical features: {Features of bladder outlet obstruction} -age below 50yrs. -hesitancy,itermitancy,weak stream,increase freq.,dysurea and in sever cases retention is the end result. Exam---- palpable scar at the urethra.

URETHRAL STRICTURE

Dx Hx., Ex., Ix urethrogram. urethroscope.

URETHRAL STRCUTRE

Complications of U.S: retention., urethral diverticulum., periurthral abscess., urethral fistula., featurs of abdominal straining{hernia,heamorrhoid,rectal prolapse}.

TREATMENT

Dilatation meatal sounds., Elastic bougie., filform and follower., self dilation.

TRATMENT

Optical urethrotomy internal visual urethrotomy. Seam to cure about 50% of the cases especially if it is followed by self dilation post opertively.

TREATMENT

Urethroplasty: this include resection of the strictured {fibrosed} part with end to end anastamosis., the anastamosis should be tension- free and to avoid that tension sometime we use urethral substitute like buccal mucosa,penile skin,or perneal skin to bridge the gap created by resection of large fibrosed segment of the urethra.