STRIKTUR URETHRA

John Kurniawan
DEFINISI
• A urethral stricture is a scar in or around
the urethra, it may present an occlusion or
reduction of his caliber, which can block the
flow of urine, and is a result of
inflammation, injury or infection.
ANATOMI URETHRA
• The male urethra is a fibromuscular tube
that drains urine from the bladder. It has a
longer, more complicated, course than the
female urethra and is also more prone to
pathology.
• The male urethra measures, on average,
18-20 cm in length
Anatomi urethra
Posterior and anterior urethra
The male urethra is divided into
the anterior and posterior
urethra. The posterior urethra
consists of the segment that
extends from the bladder neck to
the distal external urethral
sphincter and can be divided into
the prostatic urethra and the
membranous urethra. The
anterior urethra extends from
the distal external urethral
sphincter to the external urinary
meatus and is divided into the
bulbar, penile and navicularis
urethra.
ETIOLOGI
• Male urethral stricture may be due to congenital
abnormality or acquired diseases
• Congenital :
1. Hypospadias
2. Urethral valve
3. Diverticulum or urethral duplication
Etiology of non-congenital male urethral
strictures
1. Trauma

Any type of traumatic urethral lesion or

disruption can cause a urethral stricture.

Pelvic trauma associated with posterior

urethral disruption

Blunt perineal trauma associated with

bulbar urethral lesion

Penile trauma during sexual intercourse

associated with penile urethral lesion
 2. Infection
The most frequent cause of urethral stricture is the
blennorrhagia

3. Disease of the penile skin

The most frequent cause of

urethral stricture is Lichen
sclerosus

4. Surgery for hypospadias repair

Many patients who had

undergone hypospadias
repair during childhood
developed a urethral
stricture as an adult. These
patients are classified as
“Failed hypospadias
repair”.
 5. Urethral instrumentation

Endoscopic
procedures
Urethral catheter

6. Cancer
Any type of primary urethral tumor may cause urethral strictures. Primary penile
cancer may cause urethral involvement and stricture.

7. Idiopathic
It is sometimes not possible
to establish the stricture
etiology in some patients.
These “strictures of
unknown etiology” have
been related to
unrecognized minor trauma
occurring in childhood.
GEJALA KLINIK
• Pancaran lemah, menetes
• Memercik
• Intermittent
• Miksi dengan usaha
• Lambat keluar
• Terminal dribble

• Frekuensi
• Urgensi
• Nocturia
• Acute urinary retention
• Recurrent urinary tract infection
 RADIOLOGI
Urethrography
Urethrography. This radiological examination of the urethra is performed with the use
of contrast medium. Retrograde and voiding urethrography is the most basic exam for
studying the urethra.
• Retrograde urethrography (RUG)
Prosedur RUG
• Pasang foley kateter melalui MUE sedalam 1-2 cm
• Dengan panduan flouroscope, kontras dimasukkan 25-30
ml
• Perhatikan caliber urethra saat kontras diinjek --- foto
diambil
• Voiding Cystourethrography (VCUG)
Prosedur VCUR
• Pasang foley kateter melalui MUE sampai vesica urinaria
• Masukkan kontras sebanyak 150-200 ml --- lepas kateter
• Suruh pasien mengedan, dengan panduan fluoroscope
foto diambil