Surgical repair of the URETHRA, usually to relieve a stricture (see under URETHRA, DISEASES OF AND INJURY TO).
n. surgical repair of the urethra, especially a urethral *stricture. Anastomotic urethroplasty is used for a short stricture: the area of narrowing is excised and the two adjacent ends are then joined directly to each other. A substitution urethroplasty entails the insertion of a flap or patch of skin from the scrotum or a buccal mucosal graft into the urethra at the site of the stricture, which is laid widely open. The operation can be performed in one stage, although two stages are usual in the reconstruction of a posterior urethral stricture (see urethrostomy). Transpubic urethroplasty is performed to repair a ruptured posterior urethra following a fractured pelvis. Access to the damaged urethra is achieved by partial removal of the pubic bone.
Trauma Injury to the urethra is often the result of severe trauma to the pelvis – for example, in a car accident or as the result of a fall. Trauma can also result from catheter insertion (see CATHETERS) or the insertion of foreign bodies into the urethra. The signs are the inability to pass urine, and blood at the exit of the urethra. The major complication of trauma is the development of a urethral stricture (see below).
Urethritis is in?ammation of the urethra from infection.
Causes The sexually transmitted disease GONORRHOEA affects the urethra, mainly in men, and causes severe in?ammation and urethritis. Non-speci?c urethritis (NSU) is an in?ammation of the urethra caused by one of many di?erent micro-organisms including BACTERIA, YEAST and CHLAMYDIA.
Symptoms The classic signs and symptoms are a urethral discharge associated with urethral pain, particularly on micturition (passing urine), and DYSURIA.
Treatment This involves taking urethral swabs, culturing the causative organism and treating it with the appropriate antibiotic. The complications of urethritis include stricture formation.
Stricture This is an abrupt narrowing of the urethra at one or more places. Strictures can be a result of trauma or infection or a congenital abnormality from birth. Rarely, tumours can cause strictures.
Symptoms The usual presenting complaint is one of a slow urinary stream. Other symptoms include hesitancy of micturition, variable stream and terminal dribbling. Measurement of the urine ?ow rate may help in the diagnosis, but often strictures are detected during cystoscopy (see CYSTOSCOPE).
Treatment The traditional treatment was the periodic dilation of the strictures with ‘sounds’
– solid metal rods passed into the urethra. However, a more permanent solution is achieved by cutting the stricture with an endoscopic knife (optical urethrotomy). For more complicated long or multiple strictures, an open operation (urethroplasty) is required.... urethra, diseases of and injury to
n. an operation to divide the pubic bone near the symphysis, the front midline where the left and right pubic bones meet. Pubiotomy is now only rarely performed during childbirth if it is necessary to increase the size of an abnormally small pelvis to allow passage of the child and a Caesarean section is contraindicated. It is occasionally also done to facilitate access to the base of the bladder and the urethra during complex urological procedures (e.g. *urethroplasty).... pubiotomy
n. a narrowing of any tubular structure in the body, such as the oesophagus (gullet), biliary tract, bowel, ureter, or urethra. A stricture may result from inflammation, muscular spasm, growth of a tumour within the affected part, or from pressure on it by neighbouring organs. For example, a urethral stricture is a fibrous narrowing of the urethra, usually resulting from injury or inflammation. The patient has increasing difficulty in passing urine and may develop urinary *retention. The site and length of the stricture is assessed by *urethrography and urethroscopy, and treatment is by periodic dilatation of the urethra using *sounds, *urethrotomy, or *urethroplasty. Strictures in the gastrointestinal tract may be dilated by *balloons or treated surgically by *stricturoplasty or division stricturotomy. Symptomatic malignant strictures can be managed by insertion of a *stent to relieve the obstruction, especially in cases of oesophageal, colonic, or biliary strictures.... stricture
n. the operation of creating an opening of the urethra in the perineum in men. This can be permanent, to bypass a severe *stricture of the urethra in the penis, or it can form the first stage of an operation to cure a stricture of the posterior section of the urethra (*urethroplasty).... urethrostomy
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