Question

Ruth Jolly, a 43-year-old female client, is admitted with a history of a urinary stricture and bladder diverticulum, diagnosed by a voiding cystourethrogram. The client is gravida 6, para 6 and 3 of the births were instrument births, with fourth-degree lacerations involving rectal and urethra tears, which were repaired. The client has an active bladder infection and is currently taking trimethoprim (Primsol), 200 mg po once daily for 60 days, and is on day 10. The client is allergic to penicillin and sulfa. The vital signs are T, 99° F; BP, 110/70 mm Hg; HR, 80 beats/minute; RR, 22 breaths/minute. The client reports having had several urethra dilations in the past and the first stage of the urethroplasty with cystostomy tube and is going for the urethra graft today and placement of a splinting catheter. The client asks the LPN/LVN what to expect after surgery today.

a. What could be the possible cause for the client’s urinary stricture and bladder diverticulum?

b. Explain the past and current treatments of the urethra stricture and bladder diverticulum the client has had or is going to have today.

Answer 1

A. Urethral stricture is the scarring and narrowing of the urethra. The pecularity of female urethra is, ti us small and measuring 4 cm, hence high chances of developing UTI.

A bladder diverticulum is the outpouching of the walls of bladder.

The possible causes of clients urinary stricture and bladder diverticulam already explained in her past history itself. Age is forst factor, as the age of the client (43 yeras) increases the channces opf muscle tone decrease. Here also same thing can influence.Advance age of the patient, then her pregnancy status ( she delivered 6 times) this will cause loosening of the vaginal and urethral muscles. She also underwent instrumental deliveries, and developed 4th degree rectal and urethral tears. the client also had the history of several urethra dilatations.

Trauma or any kind of repeated injuries to the urethra(4th degree urethral tear), frequent medical insruments use( dilatations, and instrumental deliveries) Frequent UTI,are the major cause of urethral stricture.

A bladder diverticulum usually develops because of frequent dilatation by dilators and frequent instrumental use and surgeries.. The patient had all these histories. Hence she developed this condition.

B. The past and current treatments of the urethra stricture and bladder diverticulum the client has had or is going to have

Past treatemnt

• Urethral dilatation: urethral dilatation is the procedure, where the urethra (external opening) is  stretched under local or general anaesthetic agent. After lubricating the urethra with local anaesthetic gel, stretch and enlarge  the urethra using dilators (plastic or metal, pictured) of increasing size. Usually the procedure starting with a small thin dilator, and slowly progressing to a wider one. The procedure usually takes 5-10 minutes to complete. Mild burning sensation while urinating or bleeding for a short time after the procedure is common.
• urethroplasty: A gold standard surgical procedure for urethral stricture managemnt.This is an open surgical reconstruction of the urethra that has been narrowed.The recovery rate of this surgery is very high. It includes, different types of surgeries.
• Cystostomy: Cystostomy is t the surgical creation of an opening into the bladder.the procedure is usually performed via an incision made in the symphysis pubis. This surgery is usually performed in case of Acute urinary retention in which a urethral catheter cannot be passed. Here also, since the patient is having narrowing of the urethra, this surgery is performed.

Present treatment

• Urethra graft: This is a surgical procedure usually performs for strictures. Where graft from different body parts are used for the managemnt of strictures. The most commonly used grafts are buccal grafts. They are widely used. In urethral graft surgery the graft from body part is used to replace the nonfunctioning strictured urethral walls.They have long term success rate.
• Use of Splinting catheters: Spilinting catheters are used to maintain the uretral allignment and urinary diversion. they are used either alone or in combination with other known surgical repair.