Urethral stricture
A. DEFINITIONSUrethral stricture is a narrowing of the lumen of the urethra due to abdominal tissue and contraction. (C. Smeltzer, Suzanne; 2002)Urethral strictures are more common in men than women, especially due to the difference in length urethra. (C. Long, Barbara; 1996)B. CAUSE
Urethral stricture may occur:a. Congenital
Urethral stricture may occur separately or in conjunction with other urinary tract anomalies.b. Obtained.• urethral injury (due to the insertion of surgical instruments during transurethral surgery, indwelling catheters, or procedures sitoskopi)• Injuries caused by stretching• Injuries caused by accidents• Urethritis gonorheal untreated• Infection• muscle spasm• dai outside pressure such as tumor growth (C. Smeltzer, Suzanne; 2002 and C. Long, Barbara; 1996)
C. CLINICAL• The power emitted and the amount of urine is reduced• Symptoms of infection• Urinary Retention• The existence of reverse flow and trigger cystitis, prostatitis, and pyelonephritis(C. Smeltzer, Suzanne; 2002)The degree of narrowing of the urethra:a. Lightweight: if occlusion occurs less than one third the diameter of the lumen.b. Medium: occlusion third s.d half the diameter of the lumen of the urethra.c. Weight: occlusion greater than ½ the diameter of the lumen of the urethra.There is a palpable degree of weight sometimes hard tissue known as the corpus spongiosum spongiofibrosis.(Basuki B. Purnomo; 2000).Pathways
Congenital AcquiredInfectionOther urinary tract anomalies muscle spasmExternal pressure: Injury urethral tumorStretch injuryUrethritis gonorrhea
Narrowing of the lumen urethral scarring
Beam power and the amount of urine is reducedTotal clogged
Obstruction of the urinary tract to the bladder that empties
Increase in bladder pressure urinary reflux
hidroureterVU wall thickeninghidronefrosis
decrease in muscle contraction VU pyelonephritis
difficulty urinating GGK
urinary retention
sistostomi incision(Long C, Barbara; R. Sjamsuhidayat, Brunner and Suddart)
D. PREVENTIONIs an important element in the prevention of urethral infection with proper handling. Urethral catheter for drainage in a long time should be avoided and care should be conducted on any type of device including urethral catheter. (C. Smeltzer, Suzanne; 2002)
E. MANAGEMENTa. Filiform bougies to pave the way if the stricture inhibit catheterb. Medika mentosa
Non-narcotic analgesics to control pain.
Antimicrobial medications to prevent infection.c. Surgery• Sistostomi suprapubic• Businasi (dilatation) with metal plugs done carefully.• Internal Uretrotomi: sikatrik urethral tissue cut with a knife otis / Sachse. Otis blindly inserted into the bladder if the stricture has not been total. If more weight with a knife Sachse visually.• Uretritimi externa: a step does open surgery pemotonganjaringan fibrosis, then performed anastomosis between the urethra tissue that is still good. (Basuki B. Purnomo; 2000 and Marilynn E. Doenges, 2000).F. EXAMINATION SUPPORTa. Urinalysis: yellow, dark brown, dark red / bright, cloudy appearance, pH: 7 or greater, bacteria.b. Urine culture: the staphylokokus aureus. Proteus, Klebsiella, Pseudomonas, e. coli.c. BUN / creatinine: increasedd. Uretrografi: pembuntuan presence or urethral stricture. To find out the length of urethral stricture made iolar photo (sisto) uretrografi.e. Uroflowmetry: to know the swift jets during micturitionf. Uretroskopi: To determine pembuntuan urethral lumen (Basuki B. Purnomo; 2000 and Marilynn E. Doenges, 2000)
G. ASSESSMENT1. Circulation.Signs: increase in TD (kidney enlargement effect)2. Elimination.Symptoms: decreased urine flow, inability to empty the bladder completely, encouragement and frekurnsi urinationMark: the future / blockage in the urethra3. Food and fluidSymptoms, anorexia; nausea, vomiting, weight loss4. Pain / comfortSuprapubic pain5. Security: fever6. Counseling / learning (Marilynn E. Doenges, 2000).
Nursing Diagnosis ARISING1. B.d pain sitostomi suprapubic incision surgeryObjective: pain reduced / lostExpected outcomes:a. Reported a decrease in painb. Facial expressions and body position looks relaxedIntervention:• Assess the nature, intensity, location, duration and trigger factors and pain relief• Assess nonverbal signs of pain (anxiety, brow furrowed, jaw clenched, improved TD)• Provide comfort measures optionHelp patients find a comfortable positionTeach relaxation techniques and guided imagery help• Document and observation of the desired drug effects and side effects• In intermittent irrigation catheter urethral / suprapubic sesuaiadvis, use sterile normal saline and sterile syringeEnter the liquid slowly, not too strong.Continue irrigation until the urine is clear there is no clot.• If the action fails to reduce pain, consult your doctor for a replacement dose of medication or interval.2. Changes in the pattern of urinary elimination bd sitostomi suprapubicExpected outcomes:a. catheters remain patent in placeb. Irrigation clot out of the bladder wall and do not obstruct the flow of blood through the catheterc. Irrigation return flow through the exit without retentiond. Urine output of more than 30 ml / houre. Without excessive urination flow or when retention is eliminatedIntervention:• Assess and urethral or suprapubic catheter for patency• Assess the color, character and flow of urine and the clot through the catheter every 2 hours• Record the amount of urine irigan and output, reduce the output of irigan, report retention and urinary output of <30 ml / hour• Tell your doctor if there is a complete blockage of the catheter to remove the clot• Maintain continuous bladder irrigation according to the instructions• Use sterile normal saline for irrigation• Maintain sterile technique• Enter the irrigation solution through the smallest hole of the catheter• Adjust the flow solution at 40-60 drops / min or to maintain clear urine• Assess the frequent holes flow towards kepatenan• Give 2000-2500 ml of oral fluid / day unless contraindicated
3. The risk of infection bd the suprapubic catheter, suprapubic incision surgical sitostomiObjective: prevent infectionExpected results:a. Patient's body temperature within normal limitsb. Dry surgical incision, no infectionc. Urination with clear urine without difficultyIntervention:• Check the temperature every 4 hours and report jikadiatas 38.5 degrees C• Pay attention to the character of the urine, report if turbid and foul odors• Assess the incision pain, redness, swelling, the leakage of urine, once every 4 hours• Change the bandage using sterile technique• Maintain a closed gravity drainage system• Monitor and report signs and symptoms of urinary tract infection• Monitor and report if redness, swelling, pain or any leakage around the suprapubic catheter. (M. Tucker, Martin; 1998)
REFERENCES:1. Wim de Jong, Textbook of Surgery, Interpreting language R. Sjamsuhidayat Medical Publishers, EGC, Jakarta, 19972. Long C, Barbara, Medical Surgical Nursing, Volume 3, Bandung, Padjadjaran IAPK Foundation, 19963. M. Tucker, Martin, Standard Patient Care: Nursing Process, Diagnosis and Evaluation, Volume V, Volume 3, Jakarta, EGC, 19984. Susanne, C Smelzer, Medical Surgical Nursing (Brunner & Suddart), VIII Edition, Volume 2, Jakarta, EGC, 20025. Basuki B. purnomo, Basics of Urology, Malang, Brawijaya Medical School, 20006. E. Doenges Marilynn, Nursing Care Plans: Guidelines for Planning and Documenting Patient Care, Jakarta. EGC. 2000
A. DEFINITIONSUrethral stricture is a narrowing of the lumen of the urethra due to abdominal tissue and contraction. (C. Smeltzer, Suzanne; 2002)Urethral strictures are more common in men than women, especially due to the difference in length urethra. (C. Long, Barbara; 1996)B. CAUSE
Urethral stricture may occur:a. Congenital
Urethral stricture may occur separately or in conjunction with other urinary tract anomalies.b. Obtained.• urethral injury (due to the insertion of surgical instruments during transurethral surgery, indwelling catheters, or procedures sitoskopi)• Injuries caused by stretching• Injuries caused by accidents• Urethritis gonorheal untreated• Infection• muscle spasm• dai outside pressure such as tumor growth (C. Smeltzer, Suzanne; 2002 and C. Long, Barbara; 1996)
C. CLINICAL• The power emitted and the amount of urine is reduced• Symptoms of infection• Urinary Retention• The existence of reverse flow and trigger cystitis, prostatitis, and pyelonephritis(C. Smeltzer, Suzanne; 2002)The degree of narrowing of the urethra:a. Lightweight: if occlusion occurs less than one third the diameter of the lumen.b. Medium: occlusion third s.d half the diameter of the lumen of the urethra.c. Weight: occlusion greater than ½ the diameter of the lumen of the urethra.There is a palpable degree of weight sometimes hard tissue known as the corpus spongiosum spongiofibrosis.(Basuki B. Purnomo; 2000).Pathways
Congenital AcquiredInfectionOther urinary tract anomalies muscle spasmExternal pressure: Injury urethral tumorStretch injuryUrethritis gonorrhea
Narrowing of the lumen urethral scarring
Beam power and the amount of urine is reducedTotal clogged
Obstruction of the urinary tract to the bladder that empties
Increase in bladder pressure urinary reflux
hidroureterVU wall thickeninghidronefrosis
decrease in muscle contraction VU pyelonephritis
difficulty urinating GGK
urinary retention
sistostomi incision(Long C, Barbara; R. Sjamsuhidayat, Brunner and Suddart)
D. PREVENTIONIs an important element in the prevention of urethral infection with proper handling. Urethral catheter for drainage in a long time should be avoided and care should be conducted on any type of device including urethral catheter. (C. Smeltzer, Suzanne; 2002)
E. MANAGEMENTa. Filiform bougies to pave the way if the stricture inhibit catheterb. Medika mentosa
Non-narcotic analgesics to control pain.
Antimicrobial medications to prevent infection.c. Surgery• Sistostomi suprapubic• Businasi (dilatation) with metal plugs done carefully.• Internal Uretrotomi: sikatrik urethral tissue cut with a knife otis / Sachse. Otis blindly inserted into the bladder if the stricture has not been total. If more weight with a knife Sachse visually.• Uretritimi externa: a step does open surgery pemotonganjaringan fibrosis, then performed anastomosis between the urethra tissue that is still good. (Basuki B. Purnomo; 2000 and Marilynn E. Doenges, 2000).F. EXAMINATION SUPPORTa. Urinalysis: yellow, dark brown, dark red / bright, cloudy appearance, pH: 7 or greater, bacteria.b. Urine culture: the staphylokokus aureus. Proteus, Klebsiella, Pseudomonas, e. coli.c. BUN / creatinine: increasedd. Uretrografi: pembuntuan presence or urethral stricture. To find out the length of urethral stricture made iolar photo (sisto) uretrografi.e. Uroflowmetry: to know the swift jets during micturitionf. Uretroskopi: To determine pembuntuan urethral lumen (Basuki B. Purnomo; 2000 and Marilynn E. Doenges, 2000)
G. ASSESSMENT1. Circulation.Signs: increase in TD (kidney enlargement effect)2. Elimination.Symptoms: decreased urine flow, inability to empty the bladder completely, encouragement and frekurnsi urinationMark: the future / blockage in the urethra3. Food and fluidSymptoms, anorexia; nausea, vomiting, weight loss4. Pain / comfortSuprapubic pain5. Security: fever6. Counseling / learning (Marilynn E. Doenges, 2000).
Nursing Diagnosis ARISING1. B.d pain sitostomi suprapubic incision surgeryObjective: pain reduced / lostExpected outcomes:a. Reported a decrease in painb. Facial expressions and body position looks relaxedIntervention:• Assess the nature, intensity, location, duration and trigger factors and pain relief• Assess nonverbal signs of pain (anxiety, brow furrowed, jaw clenched, improved TD)• Provide comfort measures optionHelp patients find a comfortable positionTeach relaxation techniques and guided imagery help• Document and observation of the desired drug effects and side effects• In intermittent irrigation catheter urethral / suprapubic sesuaiadvis, use sterile normal saline and sterile syringeEnter the liquid slowly, not too strong.Continue irrigation until the urine is clear there is no clot.• If the action fails to reduce pain, consult your doctor for a replacement dose of medication or interval.2. Changes in the pattern of urinary elimination bd sitostomi suprapubicExpected outcomes:a. catheters remain patent in placeb. Irrigation clot out of the bladder wall and do not obstruct the flow of blood through the catheterc. Irrigation return flow through the exit without retentiond. Urine output of more than 30 ml / houre. Without excessive urination flow or when retention is eliminatedIntervention:• Assess and urethral or suprapubic catheter for patency• Assess the color, character and flow of urine and the clot through the catheter every 2 hours• Record the amount of urine irigan and output, reduce the output of irigan, report retention and urinary output of <30 ml / hour• Tell your doctor if there is a complete blockage of the catheter to remove the clot• Maintain continuous bladder irrigation according to the instructions• Use sterile normal saline for irrigation• Maintain sterile technique• Enter the irrigation solution through the smallest hole of the catheter• Adjust the flow solution at 40-60 drops / min or to maintain clear urine• Assess the frequent holes flow towards kepatenan• Give 2000-2500 ml of oral fluid / day unless contraindicated
3. The risk of infection bd the suprapubic catheter, suprapubic incision surgical sitostomiObjective: prevent infectionExpected results:a. Patient's body temperature within normal limitsb. Dry surgical incision, no infectionc. Urination with clear urine without difficultyIntervention:• Check the temperature every 4 hours and report jikadiatas 38.5 degrees C• Pay attention to the character of the urine, report if turbid and foul odors• Assess the incision pain, redness, swelling, the leakage of urine, once every 4 hours• Change the bandage using sterile technique• Maintain a closed gravity drainage system• Monitor and report signs and symptoms of urinary tract infection• Monitor and report if redness, swelling, pain or any leakage around the suprapubic catheter. (M. Tucker, Martin; 1998)
REFERENCES:1. Wim de Jong, Textbook of Surgery, Interpreting language R. Sjamsuhidayat Medical Publishers, EGC, Jakarta, 19972. Long C, Barbara, Medical Surgical Nursing, Volume 3, Bandung, Padjadjaran IAPK Foundation, 19963. M. Tucker, Martin, Standard Patient Care: Nursing Process, Diagnosis and Evaluation, Volume V, Volume 3, Jakarta, EGC, 19984. Susanne, C Smelzer, Medical Surgical Nursing (Brunner & Suddart), VIII Edition, Volume 2, Jakarta, EGC, 20025. Basuki B. purnomo, Basics of Urology, Malang, Brawijaya Medical School, 20006. E. Doenges Marilynn, Nursing Care Plans: Guidelines for Planning and Documenting Patient Care, Jakarta. EGC. 2000
