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

Image: Urethral Prolapse Ligated Over a Foley Catheter by Okorie CO CC BY 3.0

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

Bulbar urethral stricture (arrow) bladder diverticula (circle). with an average age of 43.8 years, however the age group most concerned was that of 50 -60 years. Some authors have found an average age of 40 years with extremes of 9 and 78 years, averages between 25 and 55 years and extremes of 0.06 and 90 years [5] [6] [7] [8]. All these studies showed that stenosis appeared

Image: Retrograde urethrocystography demonstrates a single stenosis of the bulbar urethra, which is tight and long, associated with a large diverticula of the bladder CC BY 4.0

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