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More Than Meets the UTI. Group 6 – Jack Blake, Robert Cooke, Mayura Damanhuri, Nur Romli, Adam Ting & Alicia Yong. Background Information. 52 yr old Male Occupation: Baker. Presenting Complaint. Multiple urological symptoms in 2004. HIstory Presenting Complaint. Started in 2004

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more than meets the uti

More Than Meets the UTI

Group 6 – Jack Blake, Robert Cooke, Mayura Damanhuri, Nur Romli, Adam Ting & Alicia Yong

background information
Background Information
  • 52 yr old
  • Male
  • Occupation: Baker
presenting complaint
Presenting Complaint
  • Multiple urological symptoms in 2004
history presenting complaint
HIstory Presenting Complaint
  • Started in 2004

- Frank Haematuria

- Dribbling

- Fever

- Increased micturation frequency

- Reduced urine output per micturation

- Lower left loin pain

- Nocturia

- Urgency

- Dysuria

- Recurrent UTI’s every 6-7 weeks

past medical history
Past Medical History
  • Gout – 2007
  • Peptic Ulcers
social and family history
Social and Family History
  • Social History:

- Never smoked

- Drinks 0-3 units/week

- Lives and cares for Father

  • Family History:

- Father has heart problems

- Mother had dementia

medication history
Medication History
  • Currently:

- Omeprazole (Peptic Ulcers)

- Co-codamol

  • Previous:

- Erythromycin (Previous UTIs)

differential diagnosis
Differential Diagnosis
  • Prostate Enlargement

- Benign Prostate Hyperplasia

- Prostate Cancer

  • Bladder Cancer
  • Type 2 Diabetes
  • Urethral Stricture
  • Urethral Cancer
  • Prostatitis
  • Urinary Stones
investigations
Investigations
  • Urine Dipstix and culture
  • Measure urine flow rate
  • FBC, U&E’s, Glucose, and culture
  • USS
  • Abdo X-ray
  • CT Abdo
  • Flexible cystoscopy
  • Retrograde Urethrogram
urethral stricture

Urethral Stricture

Narrowing of the urethra caused by injury or disease.

urethra
Urethra
  • Female 4-5 cm
  • Male 20 cm
  • Male has four parts:

- Pre-prostatic

- Prostatic

- Membranous

- Spongy

  • Histologically:

- Transitional cell (pre- & prostatic region)

- Pseudostratified columnar (Membranous & distal aspect of Spongy)

- Stratified squamous (proximal aspect of spongy)

epidemiology
Epidemiology
  • More common in males than females
  • Chances increase with age
  • The incidence is difficult to calculate due to the number of different causes
causes
Causes
  • A history of STD
  • Any instrument inserted into the urethra:

- Catheter

- Cystoscope

  • Benign prostatic hyperplasia 
  • Injury or trauma to the pelvic area
  • Repeated episodes of urethritis
  • Pressure from an enlarging tumour near the urethra - rare.
signs symptoms
Signs & Symptoms
  • Urinary pain
  • Urinary burning
  • Urinary frequency
  • Reduced urine
  • Difficulty urinating
  • Painful erection
  • Urine retention
tests
Tests
  • Bloods, Urinalysis and Urine Culture

- Assess whether there is current infection

  • USS

- On shaft of the penis

- Determines size of the stricture

  • Cystoscopy
  • Retrograde urethrogram

- Contrast radiograph of the urethra

  • MRI Scan
management
Management
  • There are several options for the management but which one should be chosen depends on several factors:

1. Length of stricture

2. Location of stricture

3. Degree of scar tissue associated with stricture

medical therapy
Medical Therapy
  • There is no medical therapy to treat urethral stricture disease
surgical therapy
Surgical Therapy
  • Dilation
  • Urethrotomy
  • Urethral stent
  • Urethroplasty
dilation
Dilation
  • The aim is to stretch the scar
  • It involves inserting a rod into the urethra
  • Once the urethra as been stretched the bladder is usually examined using a telescopic instrument.
  • Gradually increasing sizes of rods can be used so to return the urethra to its normal diameter
urethrotomy
Urethrotomy
  • This is the indicated procedure when the stricture is less than 1.5cm
  • Performed by a transurethral incision of the stricture
  • It is performed under general anaesthesia
  • There is a possibilty that the stricture can reform.
  • Curative success rate :20%-35%.
urethral stent
Urethral Stent
  • Indications: recurrent strictures or patient unfit for surgery
  • They can be formed from stainless steel, Nitinol or Vicryl
  • They are inserted endoscopically
  • Complications: Migration of the stent to more proximal region
urethroplasty
Urethroplasty
  • Removal of the stricture and replacing with a graft
  • Graft sites include bladder, buccal and rectal mucosa.
  • The younger the patient the better results
intermittent self dilatation
Intermittent Self Dilatation
  • After either of these procedures patients may be required to be taught Intermittent Self Dilatation.
  • Patients will be asked to follow a regime which will be similar to this

- Dilate once a day for two weeks

- Dilate on alternate days for two weeks

- Dilate once a week

summary
Summary
  • The cause of urological symptoms can be difficult to diagnose
  • There are many causes for a urethral stricture so it is important to locate position of stricture.
  • There are many procedures which can be performed but they depend on the length, location and degree of scarring of the stricture
references
References
  • http://www.strictureurethra.com/
  • www. Patient.co.uk