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Laporan Kasus

Striktur Uretra

Oleh:
Jim Christover Niq, S.Ked
04054821517072

Pembimbing:
dr. H. Marta Hendry, SpU

BAGIAN ILMU BEDAH
RUMAH SAKIT Dr. MOH. HOESIN PALEMBANG
FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
2015

Marta Hendry.HALAMAN PENGESAHAN Presentasi Kasus yang Berjudul: Striktur Uretra Oleh Jim Christover Niq. S. H. Moh. dr.Ked 04054821517072 Telah diterima sebagai salah satu syarat dalam mengikuti Kepaniteraan Klinik Senior (KKS) di bagian Ilmu Bedah Rumah Sakit Dr. SpU . Palembang. Hoesin Palembang Fakultas Kedokteran Universitas Sriwijaya periode 24 Agustus-30 Oktober 2015. Oktober 2015 Pembimbing.

Marta Hendry2 1 Clinical Senior Clerkship. Mohammad Hoesin General Hospital. Dr. trauma. particularly for those older than 55. Mohammad Hoesin Palembang with the chief complain of unable to urinate since 1 day ago. On suprapubic region. Urethral stricture is a relatively common disease in men with an associated prevalence of 229-627 per 100. Palembang 2 Department of Urology. Mohammad Hoesin General Hospital. School of Medicine. Stricture incidence increases gradually with increasing age. pain or discomfort in lower abdomen. In this case. Conclusion: Urethral stricture is one of the disease that can caused the urinary retention. urinary retention is caused by urethral stricture pars bulbosa that can be seen in urethrogram. bulging (+). who are typically older men. Medical Faculty of Sriwijaya University. School of Medicine. Keywords: Urethral stricture. From the rectal touche. Diagnosis should be considered in male patient that unable to urinate especially if there is a history of urethritis. Background . Clinical Presentation: A male. cystostomy (+). which functionally has the effect of obstructing the lower urinary tract.000 males. Laboratorory test within normal limits. Palembang Background: Urethral stricture is a narrowing of the urethra caused by scarring. From physical examination. Dr. The symptoms of urinary retention are inability to urinate. Medical Faculty of Sriwijaya University. general examination was normal. palpable pain (+). 53 years old. Urethrogram of this patient show narrowing in urethral pars bulbosa Discussion: Urinary retention is one of chief complain that caused by some diseases. from inspection. bloating of the lower abdomen . urinary retention.CASE REPORT Urethral Stricture Jim Christover Niq1. there is no enlargement of prostate. or prostate surgery. came to emergency room General Hospital DR. This scar is due to fibrosis to the lumen of urethra and to a more severe level the fibrosis will occur at corpus spongiosum.

One reason is due to narrowing of the lumen of the urethra because of fibrosis in the walls. so that the urine collected in the vesica urinaria exceeded the maximum limit. Urethral stricture is a narrowing of the urethra caused by scarring. is a medical emergency because it can cause death to the patient. Urethra pars posterior in male is divided into 2 parts which is urethra pars prostatica (part of urethra that surrounded by prostate) and urethra pars membranacea. which is located on the border of the bladder and urethra. This disease is a curative treatment with surgery. which is located on the border of the urethra pars anterior and posterior. urethra pars posterior and urethra pars anterior. Urethra pars anterior in male is part of urethra that wrapped by corpus spongiosum of penis. Urethra is divided into 2 parts. While the lower urinary tract obstruction in the bladder and urethra causing urinary retention. Obstructions can occur in the upper urinary tract and lower urinary tract. Urethra anterior is consist of pars bulbosa. This scar is due to fibrosis to the lumen of urethra and to a more severe level the fibrosis will occur at .1 Urinary retention is the inability to secrete urine. and external urethral meatus. which functionally has the effect of obstructing the lower urinary tract. Obstruction of the upper urinary tract includes the kidneys and ureter with clinical manifestations in the form of colic pain or anuria.1 Urethra is a tube that connects the vesica urinaria to the urinary meatus for removal of fluids from the body. pars pendularis. and external urethral sphincter. In female. urethral length is about 23-25 cm. but not as rare as some surgical techniques can cause high disease recurrence for patients. Urethra is equipped with the internal urethral sphincter.Obstruction in the urinary system. Thus the proper and adequate treatment is necessary to avoid the risk of recurrence of urethral stricture disease. called urethral stricture. fossa navicularis. urethral length is about 3 to 5 cm long while in adult male.

2 Everything that injure the urethra can cause urethral stricture. radical prostatectomy. Historically. Urethral stricture bulbosa prevalent in men. which is congenital and acquired. Urethral stricture can be divided into two based on the cause of stricture. there will be healing epimorfosis way. with patient education and improved diagnosis and treatment methods of sexually transmitted diseases. and transurethral which are not careful done. Mucosal lining of the urethra is a continuation of the mucosa bladder. and can also be caused by a foreign object. who are typically older men. meaning that the damaged tissue is replaced by another network (connective tissue) that is not the same as the original. In the event of injury to the urethra.4 . Trauma represents a very significant etiology of urethral stricture disease. caused by iatrogenic such as medical instruments. While the anterior urethral damage to the groin up to the bulb of the urethra.corpus spongiosum.3 Urethra structure consists of a layer of mucosal and submucosal layer. However. resulting in urethral stricture. Urethral stricture also can be caused by lichen sclerosis. The mucosal consists of columnar epithelium. This leads to loss of connective tissue elasticity and narrowing urethral lumen. Urethral stricture is a relatively common disease in men with an associated prevalence of 229-627 per 100. except in the area near the external orifice. infectious urethritis is now responsible for only a small proportion of cases. ureter and kidney. particularly for those older than 55. Stricture incidence increases gradually with increasing age. The frequency of urethral damage based on location are: posterior urethral more than 95% associated with pelvic fractures. the epithelium is squamous and layered. Other mechanisms of traumatic injury include pelvic fracture-related urethral injury (PFUI) and iatrogenic injury secondary to instrumentation like catheter. Most acquired stricture are due to infection and trauma. due to the injury of the perineum in a straddle position.000 males. On the sub mucosa consists of a layer of vascular erectile. infection urethritis was the leading cause of urethral strictures.

5 The main symptoms of urethral stricture are those of obstructed and irritated micturition. The mild stage is <1/3 diameter occlusion of the lumen. Treatment of . if found periurethral abscess. Urinary flow rates can be calculated by divided urine volume with urination time. Other primary diagnostic procedures required are ultrasonography to determine any urinary retention and ultrasound examination of the upper urinary tract to rule out hydronephrosis.6 Urethral stricture can not be eliminated with any kind of drugs. a suprapubic sistostomi promptly carried out to remove the urine. Urethrocutaneous fistulas may be present and bladder may be palpable if there is chronic urinary retention. moderate and severe. using incision and antibiotics. urinary tract infection. kidney failure. abcess and fistula. and the severe is >1/2 diameter of the lumen. In the severe level. vesico-ureter reflux. Urethrogram is made to see the location of stricture. grade of urethral narrowing. urine residu. Chronic urethral discharge can be found and likely to be associated with chronic prostatitis. the moderate is <1/3-1/2 diameter of the lumen. combined with increased micturition frequency and urgency. and symptoms on patients. urethra stricture divided into three stage which is mild. Patients who present with urinary retention. history of illnesses on patient. The additional examination such as uroflowmetry and urethrogram also very helpful. urine infiltrat.5 Diagnosis of urethral stricture can be made by anamnesis to knowing the risk factor. Normal urinary flow rate in adult men is 20 ml/s and urinary flow rate less than 10 ml/s indicate obstruction. and length of stricture. Uroflowmetry records the urine stream (measured as volume per unit of time) and the overall urination time. sacculasi and diverticel.5 Complications of urethral stricture are trabeculasi.Based on the stage of narrowing of the lumen. with increased urination time and a feeling of incomplete bladder emptying. sometimes palpable hard tissue in the corpus spongiosum known as spongiofibrosis.

the patient complained difficult while urinating (+). after a long time. as the catheter. lessened force and size of the stream of urine (+). patient complained unable to urinate at all. Early treatment of urethral strictures can avoid complications such as infection and kidney failure. Internal urethrotomi is done by cutting scar in urethra with Otis or Sachse. so patients must often undergo regular examinations by a doctor. External urethrotomi is open surgical repair with excision of fibrosis and then anastomosis will be made between healthy urethra.6 Ways to prevent the occurence of urethral stricture is by avoiding trauma to the urethra and pelvis.2 Urethral stricture may be recur at any time and patient should not be considered cured until it has been observed for at least 1 year after therapy without sign of recurrence.2 Urethral stricture often recurs. .urethral stricture has many options and varied depending on the length and location of the stricture. avoid direct contact with patients infected with sexually transmitted diseases such as gonorrhea. Dilation may initially be required because of severe symptom of chronic urinary retention. as well as the stage of narrowing of the lumen of the urethra. 53 years old. Urinary flow rate measurement and urethrogram are helpful to determine the extent of residual obstruction. terminal dribbling of urine after going to toilet to pass the urine (+) and then. The disease is said to be cured if after observation for one year showed no signs of recurrence. To prevent recurrence of stricture. with the faithful to one partner and using condoms. and external urethrotomi. internal urethrotomi. Previously.6 Treatments of urethral stricture are dilation. came to emergency room General Hospital DR.2 Clinical Presentation A male. measures transurethral with caution. Mohammad Hoesin Palembang with the chief complain of unable to urinate since 1 day ago. Dilation of stricture is not usually curative and only temporarily enlarges the lumen. sometimes patient must do periodic dilatation and clean intermittent catheterization.

riwayat pemasangan kateter 20 tahun yang lalu dan ga masuk. terminal dribbling (+). dysuria (+). . urgency while urinating (-). He has no history of diabetes melitus and CVD. nocturia (-). abdomen and CVA region was within normal limit. Urethrogram of this patient show narrowing in urethral pars bulbosa (figure 1. frequent of urination (+). urinating discontinously (+). there is no enlargement of prostate. From the rectal touche. cystostomy (+).9 mg/dl) is normal. pyuria (-). bulging (-). no bulging and pain on CVA region. Laboratory examination show normal hemoglobin (14. cystostomy on September 2015. and no history of same diseases in his family. From the history of past illness. lessened force and size of the stream of urine (+). tenderness (+). hesitancy in starting urination (+). From physical examination. normal leukocyte (7700/mm3). dissatisfaction after urinate (+). Riwayat trauma pelvis 20 tahun yang lalu. Figure 1.Since ± 2 months before admission. From the clinical chemical such as ureum (39 mg/dl) and creatinin (0. On local examination. from inspection. general examination was normal. bloody urine (-). Back pain (-). fever (-). more than 8x/day. figure 2). stone found while urinating (-). patient complained of difficult while urinating (+). On suprapubic region. and normal BSS (118 mg/dL).8).

cancer in bladder or urethra. and dysuria. Post-micturition complaints include dissatisfaction after micturition. Voiding complaints formerly known as obstructive symptoms like hesitancy (straining during micturition). Mohammad Hoesin Palembang with the chief complain of unable to urinate since 1 day ago. Urinary retention can be caused by some diseases like benign prostatic hyperplasia (BPH). 53 years old. pain or discomfort in lower abdomen. Disscussion In this case. and bloating of the lower abdomen. quo ad vitam is dubia ad bonam and quo ad functionam is dubia ad bonam. The possible causes are urethral stricture. came to emergency room General Hospital DR. and post-micturition complaints. and urethral stricture. Prognosis for this patient. or frequency.Figure 2 This patient was diagnosed with urethral stricture. neurogenic bladder. terminal dribbling urine and intermittensi. . The symptoms of urinary retention are inability to urinate. the symptoms of this patient commonly found in lower urinary tract (LUTS). uretthrolitiasis. voiding. The symptoms of this patient commonly found in obstructive lower urinary tract symptoms that can be come from vesica or urethra. and still feels there is residual urine after micturition. The treatment for this disease is pro cystostomy and Sachse surgery. LUTS based on its mechanism is divided into symptoms during storage. From the history of past illness. nocturia. weakened urinary stream. urethrolitiasis and urethral cancers. Based on autoanamnesis. Complaints during storage once was known as the irritating symptoms like urgency. BPH. A male. polakisuria.

Possible causes in this case is the result of external trauma (straddle injury) and iatrogenic (post TURP). we found urethral stricture at the pars bulbosa. The disease is more common in men. On regio genitalia externa. the levels of hemoglobin. in this patient show normal general examination. During each follow-up. In suprapubic region. and there is no nodules. anemia. leukocytes and diff. flat on the surfaces. anal sfingter tonus good. we can diagnosed with urinary retention ec urethral stricture pars bulbosa. So. cystostomy (+). From rectal touche. because men’s urethra longer than women so its more prone to have an injury. and tenderness (+). consistensy soft. It is seen that there is no enlargement of the prostate in this patient at this time. Early treatment of urethral strictures can avoid complications such as infection and kidney failure. and normal kidney function. physical examination and several additional examination of these patients. hematocrit. Management that can be given to patients with urinary retention are treated with suprapubic cystostomy and then cut the fibrosis part of the urethra through internal uretrotomy. so the differential diagnosis of BPH can be removed. Follow-up gradually on this patient is recommended because urethral stricture more likely to be recurrence. from the anamnesis of present complaints. there is no palpable enlargement of prostate. history of the past illness. no tenderness.count within normal limits as well as clinical chemistry urea and creatinine within normal limits. Based on physical examination. there is no bloody discharge. in which show there is urine retention. The disease is said to be cured if during one year of observation. it is necessary to check the flow of the urine immediately by a doctor or by uroflowmetry and patients are encouraged to conduct periodic catheterization or Clean Intermittent Catheterization (CIC) to prevent the recurrence of strictures. it can be concluded that there are no signs of infection. no .there is a history of trauma (straddle injury) and medical instrumentation of the urethra. based on the urethrogram. Therefore. From the laboratory test. But. there is bulging (-).

Hot Topics in Urology. .2004. length. Thus. Smith’s General Urology 17 th Edition. Male urethral stricture disease. In :Kirby Roger S.com/ 6. Management of urethral stricture. Urethral Stricture Surgery:the state of the art.D. medlineplus. urethra manipulation and urinary tract infections. Edisi Kedua. Santucci RA. 5. Tanagho EA and McAninch JW. Scott M. M. html 2. AR Mundy. and determine the degree of narrowing of the urethral stricture. Jakarta: CV. with a history of blunt trauma to the pelvis. so this patient's prognosis quo ad vitam is dubia ad bonam and quo ad functionam is dubia ad bonam. J Urol 2007.. 2007. It is important to determine the best treatment for patients with urethral strictures. The main causes of urethral stricture are urethral manipulation and trauma.177:1667-74. as well as radiological like urethrogram to locate. Wise M. straddle injury.82:489-493/www. http: // www. p.symptoms of recurrence. London : Elsevier Limited.Michael P O’Learly. 3. 4. Post Grad Medical Journals. Purnomo BB. In . the diagnosis should be considered in males who complain unable to urinate. The goal is to get an accurate diagnosis and know the possible causes. Conclussion Urethral stricture is a narrowing of the lumen urethra because of fibrosis. com/ medicalencyclopedia. New York: McGraw Hill. Columbia-Presbyterian Medical Center. The most important examination is the laboratory to determine the presence of infection and kidney damage. Gilbert.Anthony R Mundy. Chapter 19. Urethral Stricture. Refferences 1. New York.2006. Joyce GF. Most patients complain with urine retention. 239-252. Andrich Daniela E. Sagung Seto. Dasar-Dasar Urologi. Department of Urology. postgradmedj.