NURSING CARE OF PATIENT

URETHRAL STICTURE

BY

Ria Rahmawati (9103012012)

Agustinus klau (9103012008)
Imakulata lede (9103013044)

FACULTY OF NURSING

CHATOLIC UNIVERSITY OF WIDYA MANDALA SURABAYA

2014
 CHAPTER 1

INTRODUCTION

1.1. Background

Remove urine through the urethra. Female urethra is much shorter than the male
urethra is only 4 cm in length in comparison with a length of about 20 cm in men.
Anatomical differences cause ascending urinary tract infection incidence is higher in
women. thus the colony count of more than 100,000 bacterial cells permililiter
pathological urine is considered significant. Internal sphincter at the top of the exit from
the bladder, consisting of smooth muscle and under autonomous control. Adala external
sphincter of skeletal muscle and is under the control of folunter. Urethra in men has a
dual function as a channel for urine and sperm through coitus.

Urethral stricture disease or disorder is a narrowing or constriction of the lumen

of the urethra due to obstruction. Stricture urethra also called constriction resulting from
the formation of fibrotic tissue (scar tissue) in the urethra or the urethra.

1.2. PURPOSE

1.2.1 General Purpose

The general objective of the authors in preparing this paper is to support teaching and
learning activities, especially in the nursing department of nursing courses Urinary System on
Nursing Clients with urethral stricture

1.2.2 Specific Objectives

Students are able to:
1. Knowing the sense of urethral stricture
2. Know the classification on urethral stricture
3. Knowing the etiology of urethral stricture
4. Knowing pathophysiological urethral stricture
5. Knowing the clinical manifestations of urethral stricture.
6. Knowing investigation on urethral stricture.
 7. Knowing the management of urethral stricture
8. Knowing Nursing in patients with urethral stricture

1.3 STRUCKTURE
1. What is urethral stricture ?
2. How does the classification of urethral stricture?
3. How the etiology of urethral stricture?
4. How pathophysiological urethral stricture?
5. How clinical manifestations urethral stricture?
6. How investigation of urethral stricture ?
7. How does the management of urethral stricture?
8. How Nursing in patients with urethral stricture ?
 CHAPTER II

REVIEW OF THE LITERATURE

2.1 DEFINITION

 Urethral stricture is a narrowing of the lumen of the urethra due to abdominal tissue and
contraction. (C. Smeltzer, Suzanne; 2002 case 1468)

 Urethral stricture is more common in men than women primarily because of differences
in the length of the urethra. (C. Long, Barbara; 1996 case 338)

 Urethral stricture is Narrowing or blockage of the lumen of the urethra as a result of the
formation of fibrotic tissue (scar tissue) in the urethra and / or the urethra fairy region.

 Stricture urethra causing disturbances in urination, urinary flow ranging from shrinking
until completely unable to drain urine out of the body. Urine can not get out of the body
can lead to many complications, with the heaviest complication is kidney failure.

2.2 Etiology

Urethral stricture may occur:

1. Congenital

Urethral stricture may occur separately or in conjunction with other urinary tract
anomalies.

2. Injury.

 Urethral injury (due to the insertion of surgical instruments during surgery

transuretral, indwelling catheters, or procedures sitoskopi)

 Injuries caused by stretching

 Injuries caused by accidents

 Urethritis gonorheal untreated

  muscle spasm

 Pressure outside dai eg tumor growth

(C. Smeltzer, Suzanne; 2002 and the 1468 C. Long, Barbara; 1996 case 338)

3. Postoperative

Some operations on the urinary tract can cause urethral stricture, such as prostate
surgery, surgery with endoscopic instruments.

4. Infection

Is a factor that most often lead to urethral stricture, such as infection by germs that
cause gonococcal urethritis or non gonorrhoika gonorrhoika infects the urethra several
years earlier but now it is rarely due to the use of antibiotics, most of the stricture is located
in the pars membranasea, although it is also found in other places; chlamidia infection is
now a major cause but can be prevented by avoiding contact with infected individuals or
using condoms.

2.3 Pathophysiology

In these circumstances, the bladder must contract more forcefully to arrive at a

later moment will weaken. Original bladder muscle thickening that occurs trabeculation
phase compensation, then arise sakulasi (protrusion of the mucosa is still in the muscles)
and diverticular (sticking out) on the phase of decompensation. In this phase there will be
residual urine that facilitate the occurrence of infection. The pressure in the bladder so
high will cause reflux of urine back into the ureter, even to the kidneys. Infection and
reflux can cause acute or chronic pyelonephritis and then lead to kidney failure.
(Mansjoer, Arif. 2000).

Lesions in the epithelium of the urethra or breaking continuity, either by the

process of infection or trauma, may lead to inflammation and fibroblastic reaction.
Irritation and urine in the urethra will invite ongoing fibroblastic reaction and fibrosis
process so that there was more intensified even narrowing the lumen of the urethra and
obstruction of urine flow have problems with all its consequences. Extravasation of urine
 in the urethra which lesions will invite periurethral inflammation that can develop into
periurethral abscess and fistula formation uretrokutan (localization of the penis, or
scrotum and perineum). (Nursalam, 2008).

The structure consists of layers of the urethral mucosa and submucosal layers.
Mucosal lining of the urethra is a continuation of the bladder mucosa, ureters, and
kidneys. Mucosa consists of columnar epithelium, except in the area near the external
orifice epitelnya squamous and layered. Submukosanya consists of a layer of vascular
erectile. Urethral stricture can result from inflammation, ischemic, or traumatic. In case
of irritation of the urethra, there will be a healing process epimorfosis way, meaning the
damaged tissue is replaced by connective tissue that is not the same as the original. This
connective tissue causes the formation of scar tissue that provides elasticity and minimize
the loss manifestation urethral lumen. (Muttaqin, Arif. 2012).

2.4 Signs and symptoms

 The strength of the emission and the amount of urine is reduced

 Symptoms of infection

 Urinary Retention

 The presence of back flow and trigger cystitis, prostatitis, and pyelonephritis

(C. Smeltzer, Suzanne; 2002 case 1468)

The degree of narrowing of the urethra:

 Lightweight: if occlusion occurs less than one third the diameter of the lumen.

 Medium: occlusion third urethral lumen diameters up to 1/2.

 Weight: occlusion greater than ½ the diameter of the lumen of the urethra.
 There is a palpable sometimes severe degree of hard tissue in the corpus spongiosum
known as spongiofibrosis.

(Basuki B. Purnomo; 2000 case 126)

2.5 Investigations

a) Urinalysis: yellow, dark brown, dark red / light, cloudy appearance, pH: 7 or greater,
bacteria.
b) Urine culture: existence staphylokokus aureus. Proteus, Klebsiella, Pseudomonas, e. coli.
c) BUN / creatine: increased
d) Uretrografi: narrowing or pembuntuan urethra. To determine the length of the narrowing
of the urethra made iolar photo (sisto) uretrografi.
e) Uroflowmetri: to know the swift jet during micturition
f) Uretroskopi: To determine the urethral lumen pembuntuan

(Basuki B. Purnomo; 2000 things Marilynn E. Doenges 126 and 2000 case 672)

2.6 Treatment
1) Filiform bougies to pave the way if the stricture inhibit catheter
2) Medika mentosa
 Non-narcotic analgesics to control pain.
 Medications antimicrobials to prevent infection.
3) Surgery
 Sistostomi suprapubic
 Businasi (dilatation) with metal plugs done carefully.
 Uretrotomi interna: sikatrik urethral tissue cut with a knife otis / Sachse. Otis
blind inserted into the bladder if the stricture is not total. If more severe with
visually Sachse knife.
 Uretritimi externa: this step pemotonganjaringan fibrosis form of open surgery,
then performed an anastomosis between the urethra tissue that is still good.
(Basuki B. Purnomo; 2000 things Marilynn E. Doenges 126 and 2000 case 672)
 4) Prevention
An important element in the prevention of urethral infection is dealing with right.
Urethral catheter for drainage in a long time should be avoided and care should be
conducted on each type of equipment, including urethral catheter.
(C. Smeltzer, Suzanne; 2002 case 1468)

2.7 Complications

 Urinary retention
 Urethral diverticulum

 Periurethral abscess

 Urethral fistula

 Bilateral hydronephrosis

 Urinary infections

 Urinary calculus

 Hernia, haemorrhoids or Rectal prolapse from straining