PANCE Blueprint Genitourinary (5%)

Urethral disorders (PEARLS)

The NCCPA™ PANCE Genitourinary Content Blueprint urethral disorders

Urethral Prolapse
Patient will present as → a mother of a 3-year-old girl who is concerned because she saw blood in her daughter’s underpants. The patient complains of no pain. Examination demonstrates a complete circular eversion of the distal urethral mucosa.

Circumferential protrusion of the distal urethra through the external urethral meatus. It is a rarely diagnosed condition that occurs most commonly in prepubertal girls and postmenopausal women

  • Vaginal bleeding is the most common presenting symptom of urethral prolapse
  • Upon examination, round, often doughnut-shaped protrusion mucosa is observed obscuring the urethral opening

DX: Diagnosis is clinical and urethral prolapse is often an incidental finding during a routine examination

  • Routine evaluation with urograms and voiding cystourethrography is unnecessary except in patients who may have evidence of malignancy

TX: Treatment includes topical estrogen creams, Vaseline, and sitz baths

  • Surgical excision is justified in young patients with symptomatic urethral prolapse or with recurrent urethral prolapse
Urethral Stricture
Patient will present as → a 56-year-old male with pain during urinationdecreased urinary stream, and incomplete bladder emptying. Uroflowmetry demonstrates poor bladder emptying and a low peak rate of urine flow.

Narrowing of the urethra caused by injury, instrumentation (TURP), infection (typically with Gonorrhea), and certain non-infectious forms of urethritis

  • A urethral stricture should be suspected in men with chronic obstructive voiding symptoms, especially if noninvasive studies (e.g., uroflowmetry, ultrasound postvoid residual measurement) demonstrate poor bladder emptying with a low peak rate of urine flow

DX: Patients suspected of having a urethral stricture should undergo cystourethroscopyretrograde urethrogram (RUG)voiding cystourethrogram (VCUG), or ultrasound urethrography to establish the diagnosis

TX: Treatments include urethral dilation or stent placement

  • An open urethroplasty is an option for longer, more severe strictures
Testicular torsion (Lecture) (Prev Lesson)
(Next Lesson) Urethral Prolapse
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