68.7 Strictures after urethral injuries

Unfortunately, a stricture usually follows an injury to any part of the urethra, so any patient who has ever had a urethral injury must be regularly reviewed (22.8). Monitor his stream with a bucket and tape measure as in Fig. 23-9, or with a stop watch. If there is any deterioration at all, pass bougies to calibrate the size of his stricture, and decide whether or not to start life long bouginage. He may have an ’S’ bend deformity of his membraneous urethra, resulting from partial backwards displacement of his prostate. If you instrument him forcibly, you can easily make a false passage at the ’S’ bend. If his stream is diminishing, bouginage for life is inevitable. The secret of success is to diagnose an impending stricture early, and to start bouginage before he notices his stream is tailing off. If he has an anterior stricture, he may be able to bougie himself with the homemade bougie in Fig. 23-9. Tell him to boil it and leave it in the water until the water becomes tepid. Warn him also that he will probably have urinary infections and should present early for treatment. The strictures that follow injuries will be easier to manage if you don’t leave them too long before you start to bougie them.