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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. 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

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  1. More Than Meets the UTI Group 6 – Jack Blake, Robert Cooke, Mayura Damanhuri, Nur Romli, Adam Ting & Alicia Yong

  2. Background Information • 52 yr old • Male • Occupation: Baker

  3. Presenting Complaint • Multiple urological symptoms in 2004

  4. 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

  5. Past Medical History • Gout – 2007 • Peptic Ulcers

  6. 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

  7. Medication History • Currently: - Omeprazole (Peptic Ulcers) - Co-codamol • Previous: - Erythromycin (Previous UTIs)

  8. Differentials

  9. Differential Diagnosis • Prostate Enlargement - Benign Prostate Hyperplasia - Prostate Cancer • Bladder Cancer • Type 2 Diabetes • Urethral Stricture • Urethral Cancer • Prostatitis • Urinary Stones

  10. 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

  11. Urethral Stricture Narrowing of the urethra caused by injury or disease.

  12. 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)

  13. Epidemiology • More common in males than females • Chances increase with age • The incidence is difficult to calculate due to the number of different causes

  14. 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.

  15. Signs & Symptoms • Urinary pain • Urinary burning • Urinary frequency • Reduced urine • Difficulty urinating • Painful erection • Urine retention

  16. 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

  17. Retrograde Urethrogram of an Urethral Stricture

  18. 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

  19. Medical Therapy • There is no medical therapy to treat urethral stricture disease

  20. Surgical Therapy • Dilation • Urethrotomy • Urethral stent • Urethroplasty

  21. 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

  22. 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%.

  23. 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

  24. 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

  25. 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

  26. 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

  27. Thank You!

  28. References • http://www.strictureurethra.com/ • www. Patient.co.uk

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