Bulbar Urethra Stricture
A 26 year old male working in an electrical shop reported to me with complaints of Dysuria and frequent urge to urinate , even though little comes for past 1 week He also reported an episode of UTI four months back which resolved on its own There were no red flags like hematuria, fever, or flank pain He had an USG which revealed cystitis and right sided neprolithiasis of 3mm, no hydronephrosis I started him on Pyridium 200mg TDS 2 days along with Nitrofurantoin 100mg BD 3 days and ordered Urine R/M, CS Though his urine result had pus cells but the urine culture sample was sterile So I started him on higher antibiotics after which he was relived in frequent urge, but his dysuria continued after 1 day of stopping pyridium I even consulted the labs to get his Urine CS done again, which again came sterile So I was perplexed and referred the case to a urologist mentioning everything and asking for a USG - PVRU and a uroflometry The doctor urologist also did a RGU which reveled a bulbar urethra stricture Is there anything I could have done which could have given me an idea about stricture like advancing a Foley's or so?? But two Urine CS sample being sterile was indicative of stricture
Bulbar urethral stricture and need urethroplasty For dysurea you can ask about stream of urine in history as well as flometry could have help but RGU is beast tool to diagnose stricture or order for excretory MCU
Retrograde urethrogram showing stricture of bulbar part of urethra with complains of dysuria and frequent urge of micturation may be due to chronic retension of urine in bladder due to stricture causing obstructive uropathy leading to recurrent cystitis. Renal stone of size 3 mm without any complication may be taken care of later. Urine for culture sensitivity test and antibiotic according to report. Plenty of water by mouth Systemic alkalyser by mouth Antispasmodic sos.
Urethral stricture has one special sign to be asked or noticed...Direction of steam of urination.. CT scan of Penile Shaft could be conclusive. Though your approach is appreciable dear Dr.Ajeetji..
Structure urethra is common outcome in gonococcal urethritis, usually contracted as sexually transmitted disease Need to check for other sexually transmitted infections Early treatment with antibiotics is key for presenting prevention of urethral stricture
Bulbar urethral strictures are classified as traumatic and non-traumatic strictures depending on the etiology. Bulbar urethra is the most common site of anterior urethral stricture and this stricture develops secondary to idiopathic (40%), iatrogenic (35%), inflammatory (10%), and traumatic (15%) causes. Most commonly used techniques include dorsal onlay,ventral onlay, Asopa dorsal inlay, double- face with BMG, and non-transaction anastomotic urethroplasty, in addition to end-to-end anastomosis.
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As to your query as to what esle you could have done, 1.gone a little more into the uti and it's origin - you might have uncovered a stu 2.In every zuspected uti , if culture shows no organism, don't go overboard with antibiotics and higher ones.Try vit.c first. 3.if the patient has little result but lot of straining and burning, suspect a urethral or bladderneck calculus.Do a xray genitalia ap and oblique. 4.Make more frequent use of Uroflowetry.Both pre and post treatment.Helps in charting the progress and efficiency of treatment. In this case the RGU shows double stricture. Worth 1 attempt at VIU. Of it recurs then Urethroplasty. .
POSSIBLY S. T. D INFECTION ....... GONOCOCCAL.. URETHRITIS.
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