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Patient case: Urethral Stricture

Patient case: Urethral Stricture

Discussion

A 42-year-old male presents with a three-month history of difficulty urinating, a weak urinary stream, and frequent urination, especially at night. He also experiences intermittent dribbling after urination but denies pain, hematuria, or fever. Symptoms have progressively worsened, with the patient reporting incomplete bladder emptying after urination.

The patient's past medical and social history is unremarkable, with no history of trauma, urinary tract infections, or sexually transmitted infections. On examination, the abdomen is non-tender with no palpable masses, and the genital exam is normal. A rectal examination shows a normal-sized prostate with no signs of enlargement.

Investigations

• Urinalysis: Normal, no infection

• Post-void residual urine test: Moderate residual urine volume

• Retrograde urethrography: Reveals a narrow anterior urethral segment, confirming a diagnosis of urethral stricture.

Management

Referral to urology for urethral dilation or surgery, depending on the stricture's severity. Regular monitoring for complications such as urinary tract infections is also advised.

Questions
1. What is the most likely diagnosis for the patient based on the presented symptoms of difficulty urinating, weak urinary stream, and frequent urination?

A) Urinary tract infection

B) Urethral stricture

C) Prostate cancer

D) Bladder stone

2. Which of the following investigations confirmed the diagnosis of urethral stricture in this patient?

A) Urinalysis

B) Retrograde urethrography

C) MRI of the pelvis

D) Ultrasound of the kidney

3. Which management option is commonly used for urethral stricture?

A) Antibiotic therapy

B) Urethral dilation or surgery

C) Chemotherapy

D) Intravesical therapy

4. What is a potential complication that the patient should be monitored for after diagnosis and treatment of urethral stricture?

A) Urinary tract infections

B) Renal failure

C) Erectile dysfunction

D) Pelvic pain

Reveal answers

Answers

1. B) Urethral stricture

2. B) Retrograde urethrography

3. B) Urethral dilation or surgery

4. A) Urinary tract infections