Urinary retention ec.

Stricture of urethra
ICD 10: N35.9
level of competence: 2

ELSA PUSPITA
1608437711
 PATIENTS IDENTITY

Name : Mr. CR
Age : 23 years old
Sex : Male
Address : Pangkalan kerinci
MR : 95 38 53
Admitted to hospital : April 23rd, 2017
 CHIEF COMPLAIN
The patient came with urinary absence
since 10 hours before hospitalized
 HISTORY OF PRESENT ILLNESS
1 month before hospitalized patient could not
urinate and the lower abdomen feels tense.
There is sense of incomplete voiding and hard
to start urinate, urine flow was weak,
intermitten micturition (+), dribbling in the
end of micturition (+), pain during urinate (+),
stone in urine (-), blood in urine (-), low back
pain (-), trauma (-). Patient awakened 2-3 times
at midnight to urinate, defecation was normal.
Patient went to RSUD Air Molek and examined,
obtained the result are infection in the urinary
tract and got antibiotics.
 10 hours before hospitalized, patient could
not urinate with the lower abdomen feels
tense, and then patient went to RS Pematang
Rebah and got medical treatment, installed
tube from his penis 6 times but failed. And
then installed tube from the lower abdomen
there was urine as many as 800 cc. patient
transferred to RSUD Arifin Achmad
 HISTORY OF PAST ILLNESS
No history with same complaint
History of femoral hernia surgery on February 2017
Hypertension (-)
Diabetes mellitus (-)
 HISTORY OF FAMILY ILLNESS
No family member has same complaint as
the patient
 HISTORY OF SOCIAL ECONOMIC
Patient an employee
History of smoking and alcohol consumption
(-)
 PHYSICAL EXAMINATION
VITAL SIGN
Consciousness : Composmentis
General appearence : Mild sickness
BP : 110/70 mmHg
HR : 89 bpm
RR : 20 bpm
Temperature : 36,6 C
 GENERELIZED STATE
Head : normal
Neck : normal
Thorax : normal
Abdomen : normal
Extremities : normal
Genito-urinary tract : localized state
 LOCALIZED STATE (GENITO-URINARY
TRACT)
Flank Area
Dextra : trauma (-), inflamation (-), ballotement (-),
cva tenderness (-)
Sinistra : trauma (-), inflamation (-), ballotement (-),
cva tenderness (-)
LOCALIZED STATE (GENITO-URINARY TRACT)

Supra pubic
trauma (-), inflammation (-), cystic mass (-),
abdominal distension (+), tenderness (+)
 LOCALIZED STATE (GENITO-URINARY
TRACT)
Genitalia Externa
Penis : normal size, circumcized preputium,
trauma (-) inflammation (-), mass (-), MUE
distal

Hemiscrotum dextra : trauma (-), inflammation (-),

mass (-)
Hemiskcrotum sinistra : trauma (-), inflammation (-),
mass (-)
 LOCALIZED STATE (GENITO-URINARY
TRACT)
Testis
Dextra : located in the scrotum, normal size,
tender consistency , tenderness (-),
translumination (-)
Sinistra : located in the scrotum, normal size,
tender consistency, tenderness (-),
translumination (-)
Urinary retention ec. Susp. Stricture urethra

Suspect BPH with urinary retention

 WORK UP EXAMINATION
Urinalisis
Routine blood count
Chemical blood count
Uretrography
Uretroscopy
 LABORATORY EXAMINATION
Routine blood count
Hb : 16,0 g/dL
Ht : 48,8%
WBC : 18.400/uL
PLT : 272.000/uL
 LABORATORY EXAMINATION
Chemical blood count
Ureum : 22,2 mg/dL
Creatinin : 1,02 mg/dL
Urethrocystography

Susp cystitis and posterior

urethra stricture
Urethroscopy
Obtains urethra stricture pars bulbosa
Urinary retention ec. Stricture of urethra
TREATMENT PLAN

Pharmacologic therapy :
IVFD RL 20 dpm
Inj. ceftriaxon 2x1 gr
Inj. ketorolac 2x30 mg

Non Pharmacologic therapy :

Uretrotomy interna (Saschse)
 URINARY
RETENTION
 Urinary retention is the accumulation of urine in
the bladder with associated inability of the
bladder to empty itself.

Urinary retention can cause by infravesica,

vesica and supravesica disorders.
 Infravesica disorders
because of disorder/disease of prostate and
uretra
Vesica disorders
because of disorder/disease of bladder
Supravesica disorders
because of disorder of nerve that control the
bladder Diabetes mellitus with complication
and spinal cord injury
 URETHRA
STRICTURE
ANATOMY
DEFINITION
The urethral stricture is a narrowing of the
urethral lumen due to fibrosis in the walls.
The narrowing of the lumen is due to fibrosis
wall and to a more severe degree of fibrosis
of the corpus spongiosum.
ETIOLOGY

Infection : Most commonly infection by

gonococcal bacteria
uretral trauma : straddle injury, fracture
pelvic, instrumentation or
transuretric action,
improper catheter fixation
Congenital
CLINICAL SIGNS

Decreased urine flow

Branched urine flow
Dysuria
Urinary retention
Increased urinate frequent
Hematuria
Discomfort in the pubic area
SUPPORTED EXAMINATION
Urinalysis
Uroflowmetry
Uretrografi
Uretroscopy

TREATMENT
Busination (dilation) with metallic spark plugs done
carefully.
Internal Uretrotomy (sachse) cutting the urethral
sikatriks with an otis knife or with a sachse knife
Uretrotomy exsterna
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