2 from pg 120 of the study guide Concept What is a urethral stricture urethral

2 from pg 120 of the study guide concept what is a

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2. (from pg. 120 of the study guide) Concept: What is a urethral stricture? urethral stricture is a fibrotic narrowing of the urethra caused by scarring. The scars may be congenital but are more likely to result from trauma or untreated or severe urethral infections, most often from long-term use of indwelling urinary catheters. It can present at any age and has a wide range of etiologic factors, including infection, trauma, and instrumentation. Large catheters and instruments cause internal trauma and ischemia, whereas external trauma, such as pelvic fracture, can partially or completely sever the urethra and cause severe and complex strictures.15 In addition, a report has concluded that stricture may occur decades after initial hypospadias surgery.16 Urethral carcinoma is a less common cause of urethral stricture. Prostatitis and infection secondary to urinary stasis are common complications. Severe and prolonged obstruction can result in hydronephrosis and renal failure. In addition, chronic, severe strictures may lead to urethral fistulas and periurethral abscesses.15,17 The clinical manifestations of urethral stricture are caused by bladder outlet obstruction. The primary symptom is diminished force and caliber of the urinary stream; other symptoms include urinary frequency and hesitancy, mild dysuria, double urine stream or spraying, and postvoiding dribbling. Symptoms of acute urinary retention may occur in the presence of infection or urinary obstruction. Induration at the stricture site may be palpable. Tender, enlarged masses along the urethra usually indicate periurethral abscesses. Urethral stricture often manifests itself as lower urinary tract symptoms or urinary tract infections with significant impairment in the quality of life. Urethral stricture is diagnosed on the basis of history, physical examination, urinary flow rates, voiding cystourethrogram, and urethroscopy; biopsy confirms carcinoma. Treatment is usually surgical and may involve urethral dilation, urethrotomy, or a variety of open surgical techniques. The choice of surgical intervention depends on the age of the individual and the severity of the problem. Strictures may recur up to 1 year after treatment. Follow-up is necessary during this time; urinary flow measurements and urethrogram help determine extent of residual obstruction. (referenced from pg. 888 of the textbook) 3. (from pg. 120 of the study guide) Concept: What is peyronie disease? Peyronie disease (bent nail syndrome) is a fibrotic condition of the tunica albuginea of the penis resulting in varying degrees of curvature and sexual dysfunction19 (Figure 25-2). Peyronie disease develops slowly and is characterized by tough, fibrous thickening of the fascia in the erectile tissue of the corpora cavernosa. A dense fibrous plaque is usually palpable on the dorsum of the penile shaft. The problem usually affects middle-age men and is associated with painful erection, painful intercourse (for both partners), and poor erection distal to the involved area. In some cases, impotence or unsatisfactory penetration occurs. There is no
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