Urethral stricture is a narrowing of the lumen due to fibrosis in the wall of the urethra due to infection, urethral trauma, or congenital abnormalities.
Pathophysiology of urethral stricture
The process of inflammation due to trauma or infection of the urethra will cause the formation of cicatricial tissue in the urethra. Cicatricial tissue in the lumen of the urethra pose obstacles to the flow of urine to urinary retention. Obstructed flow of urine will be looking for a way out elsewhere (proximal stricture) and will eventually accumulate in the periurethral cavity. If infected, causing the periurethral abscess, which then rupture to form urethrocutaneous fistula. In certain circumstances encountered a lot of the fistula, thus referred to as a fistula flute.
The structure of the urethra, consists of layers of mucosa and submucosa layers. Mucosal lining of the urethra is a continuation of mucosal bladder, ureters and kidneys. Mucosa is composed of a columnar epithelium, except in the area near the external orifice, and layered squamous epithelium. Submucosal layer consists of vascular erectile.
In the event of injury to the urethra, there will be a healing way epimorphosis, meaning the damaged tissue is replaced by other tissues (connective tissue) that is not the same as the original. This leads to loss of connective tissue elasticity and reduce the lumen of the urethra, causing urethral strictures.
Examination
Laboratory
- Urine and urine culture to determine the presence of infection.
- Urea and creatinine to determine renal physiology.
Uroflowmetry
- Uroflowmetry is an examination to determine the speed of urinary stream. Urine volume issued at the time of micturition, divided by the length of the process of micturition. Normal urinary stream velocity in men was 20 mL / sec and in women 25 ml / sec. When the speed is less than the normal urinary stream indicates obstruction.
- Definitive diagnosis is made by urethrography, to see the location of the narrowing of the urethra. To find out more about the full length stricture is to create a photo bipolar cystourethrography. With this examination stricture length can be known, so it is important for planning treatment or surgery.
Instrumentation
- In patients with urethral stricture was tested by inserting a Foley catheter size 24 ch, if there are barriers fitted with a catheter with a smaller size to be able to get into the bladder. When the catheter may enter the small size indicates a narrowing of the lumen of the urethra.
Ureteroscopy
- To see directly the presence of stricture of the urethra. If it is found some strictures directly followed by internal urethrotomy (Sachse), namely by cutting fibrotic tissue using knife Sachse.
Nursing Diagnosis for Postoperative Urethral Stricture
1. Impaired Urinary Elimination related to postoperative cystostomy.
2. Acute pain related to postoperative cystostomy.
3. Risk for excess fluid volume related to bladder irrigation solution is absorbed.
4. Risk for infection, hemorrhage related to surgery.
5. Incontinence, stress or urge related to removal of the catheter after surgery.
6. Risk for se.ual dysfunction related to the disease (stricture).
7. Knowledge Deficit related to lack of information, incorrect interpretation of information.
