Urethral Stricture Flashcards
(145 cards)
1
Q
What is the lining of the posterior urethra?
A
Transitional epithelium
2
Q
What is the lining of the anterior urethra?
A
pseudostratified squamous epithelium
3
Q
What is the lining of the fossa navicularis?
A
stratified squamous epithelium
4
Q
What is narrowing of the posterior urethra called?
A
stenosis
5
Q
What is narrowing of the anterior urethra called?
A
stricture
6
Q
What are the two leading causes of urethral strictures in developed countries?
A
Idiopathic 41%
Iatrogenic 35%
7
Q
What is the leading cause of urethral stricture in developing countries?
A
Trauma 36%
8
Q
What are the common presenting symptoms of patients with urethral strictures?
A
Decreased urine stream Incomplete emptying UTI Epididymitis Decreased ejaculation
9
Q
What should be included in the workup of a patient with slow stream?
A
Thorough history Physical exam UA Urine culture PVR Uroflow/UDS Cystoscopy RUG
10
Q
What is the duration of foley catheter placement following surgery for urethral structure?
A
Typically 2-3 weeks after which a RUG or VCUG is obtained.
11
Q
What are the possible sexual side effects of urethroplasty?
A
Ejaculatory dysfunction 21%
Erectile dysfunction 1%
12
Q
What is the uroflow rate associated with urethral strictures?
A
Less than 12ml/s
13
Q
What is recommended to confirm the diagnosis of a urethral stricture?
A
Urethroscopy
RUG
VCUG
US urethography
14
Q
What is the diagnostic of choice for confirmation of urethral stricture?
A
RUG
15
Q
What information is required before planning treatment for a stricture?
A
Length and location of the stricture.
16
Q
What are the treatment options when a patient is in urinary retention and has a urethral stricture?
A
Suprapubic cystostomy
Urethral dilation
DVIU
17
Q
What should be done before definitive management for a urethral stricture if urethroplasty is being considered?
A
4-12 weeks of urethral rest with suprapubic tube if necessary to allow full stricture to declare itself.
18
Q
What are the treatment options and success rates for bulbar urethral strictures < 2cm?
A
Dilation (35-70%)
DVIU (35-70%)
Urethroplasty (80-95%)
19
Q
How does DVIU compare to dilation when endoscopic management is desired?
A
Dilation and DVIU may be used interchangeably
20
Q
What is the data regarding injection of steroids or mitomycin C at time of stricture treatment?
A
There is weak evidence to suggest that it decreases recurrence rate but stronger studies with long term follow up are needed.
21
Q
When can catheters be removed safely following DVIU or dilation?
A
24-72 hours
22
Q
What is the next step in a patient who just underwent a redo DVIU but is not a candidate for a urethroplasty?
A
They should be started on self catheterization as stricture recurrence rates were significantly lower among patients performing self-catheterization (risk ratio 0.51, 95% CI 0.32 to 0.81, p = 0.004
23
Q
What is the next step in most patients who failed at least one endoscopic procedure for urethral stricture?
A
Urethroplasty
24
Q
What is the failure rate for repeat endoscopic management of urethral strictures?
A
> 80%
25
What are the initial options for treatment of meatal or fossa navicularis strictures?
Dilation
| Meatotomy
26
What factors may complicate tx of fossa navicularis/meatal strictures?
Hypospadias repair
Failed endoscopy
Urethroplasty
Lichen sclerosis
27
What initial tx can be used for meatal strictures due to LS?
extended meatotomy in conjunction with high-dose topical steroids
28
What should be done with the patient that has recurrent meatal or fossa navicularis strictures?
Surgeons should offer urethroplasty.
29
What is the success rate of uncomplicated meatotomy?
87%
30
What is the most common method of repair for the fossa navicularis?
Penile fasciocutaneous flap
Oral mucosa graft
31
What is the success rate of penile fasciocutaneous grafts?
94%
32
What is the success rate of oral mucosal grafts?
83-100%
33
What is the recommended treatment option for penile urethral strictures?
Urethroplasty
34
A patient has a bulbar urethral stricture >2cm. What is the preferred treatment?
Urethroplasty
35
A patient has Bulbar urethral stricture >4cm. How do the success rates between endoscopic tx and urethroplasty compare for these types of strictures?
Endoscopic: 20%
Urethroplasty: >80%
36
What is the first choice graft harvest site for urethroplasty?
The inner cheek
37
What is the problem with performing a single stage tubularized graft?
High rate of restenosis
38
What are the tx options for bladder neck contracture after endoscopic prostate procedure or vesicourethral anastomoses?
Dilation
bladder neck incision
TURBN
39
What is the success rate for first time tx of vesicourethral anastomotic strictures?
50-80%
40
What are the treatment options for patients on CIC for neurogenic bladder who develop a stricture?
Urethroplasty
| Suprapubic tube
41
What should be done if lichen sclerosis is suspected?
Biopsy
42
What is the rate of squamous cell carcinoma in patients with lichen sclerosis?
2-8.6%
43
How should lichen sclerosis be treated?
Clobetasol
| mometasone
44
What should be avoided when treating lichen sclerosis?
Avoid genital skin flaps
45
What should be done to evaluate the urethra in fracture urethral injuries?
retrograde urethrography, voiding cystourethrography (VCUG) and/or retrograde urethroscopy
46
A patient has a pelvic fracture urethral injury. What treatment is recommended
Delayed urethroplasty
47
What are the methods of gaining urethral length during an anastomotic urethroplasty?
1. Mobilize the bulbar urethra
2. Crural separation
3. Inferior pubectomy and supracrural rerouting
4. Transabdominal, transpubic.
48
What is the standard amount of time to wait after a pelvic fracture urethral injury before urethroplasty?
3-6 months.
49
What is the mucosal histology of the posterior urethra, anterior urethra, and fossa navicularis?
posterior: transitional epithelium
anterior: pseudostratified columnar epithelium
fossa navicularis: stratified squamous epithelium
50
What are presenting features of urethral stricture?
decreased urinary stream
incomplete bladder emptying
UTI
epididymitis
rising PVR
decreased force of ejaculation
dysuria
spraying
51
What important factors are there to consider for positioning during urethral stricture repair?
high lithotomy
avoid pressure on calf muscles, peroneal nerve and ulnar nerve
use SCDs to prevent VTE
52
After a urethral repair, what follow up imaging is recommended?
urethrography or VCUG 2-3 weeks after
replace catheter if persistent leak to avoid inflammation, urinoma, abscess, and/or urethrocutaneous fistula
53
Clinicians SHOULD include urethral stricture in ddx of men who present with which symptoms?
GUIDELINE STATEMENT 1
decreased urinary stream
incomplete emptying
dysuria
UTI
rising PVR
\*stricture characteristics (length, diameter, duration of obstruction) lend to sxs
54
Risk factors for forming urethral stricture?
hypospadias surgery
urethral catheterization or instrumentation
traumatic injury
transurethral surgery
prostate cancer
idiopathic
inflammatory disorder (LS)
55
What non invasive measures can be performed initially in a patient with suspected urethral stricture?
GUIDELINE STATEMENT 2
H&P
UA
Uroflow
PVR
\*AUA-SS
56
What evaluations would be next step to confirm diagnosis of urethral stricture after non-invasive measures?
GUIDELINE STATEMENT 3
Cysto
RUG
VCUG
US urethrography
MRI (can provide detail in certain cases, e.g diverticulum, fistula, cancer)
57
In planning non-urgent intervention for known stricture what must be determined:
GUIDELINE STATEMENT 4
length and location
58
Patients with symptomatic stricture including urinary retention or need for catheterization, may undergo which procedures urgently?
GUIDELINES STATEMENT 5
DVIU
SPT
GUIDELINE STATEMENT 6
surgeons may place SPT prior to definitive urethroplasty depending on CIC Or foley
“urethral rest” 4-12 weeks
59
What is considered a short bulbar urethral stricture? What is an initial treatment options?
GUIDELINE STATEMENT 7
\< 2 CM
DVIU or dilation
urethroplasty
60
What types of endoscopic treatment may be offered for urethral stricture? When may catheter be removed if uncomplicated procedure?
GUIDELINE STATEMENT 8
Dilation
DVIU
GUIDELINE STATEMENT 9
72 hours
61
For pts who are not candidates for urethroplasty, who have undergone DVIU, clinicians may recommend what at home activity?
GUIDELINE STATEMENT 10
self-catheterization to maintain temporary urethral patency
ranging daily to weekly \> 4 mo reduces recurrence
62
For recurrent anterior urethral strictures, after failed dilation/DVIU, what management is recommended?
GUIDELINE STATEMENT 11
Urethroplasty
63
For surgeons who do not perform urethroplasty, what is an option?
GUIDELINE STATEMENT 12
refer to surgeon with expertise
64
Initial treatment of metal or fossa navicularis strictures?
GUIDELINE STATEMENT 13
dilation or meatotomy
as long as not associated with previous hypo repair, prior failed endoscopic treatment, previous urethroplasty, or LS
65
Recurrent metal or fossa navicularis strictures, should be treated with?
GUIDELINE STATEMENT 14
urethroplasty
\*or associated with hypospadias or LS
66
Penile urethral strictures should be treated with?
GUIDELINE STATEMENT 15
urethroplasty due to high recurrence rates with endoscopic tx
67
Patient with bulbar strictures \> 2 cm should be treated with?
GUIDELINE STATEMENT 16
urethroplasty due to low success rate of DVIU/dilation
68
Multi-segment strictures may be reconstructed utilizing what surgical technique and material?
GUIDELINE STATEMENT 17
One stage or multistage
oral mucosal graft, penile fasciocutaneous flap or combo
69
what is a long term alternative for severe complex or length strictures?
GUIDELINE STATEMET 18
perineal urethrostomy
\*recurrent complex anterior stricture, advanced age, medical co-morbidities, extensive LS, numerous failed urethroplasty, and patient choice
70
What is the first choice when using grafts for urethroplasty? What materials/donor sites shouldn't be used?
GUIDELINE STATEMENT 19
oral mucosa
\*inner cheek, be careful of salivary gland
GUIDELINE STATEMENT 20
should not perform substitution urethroplasty with allograft, xenograft, or synthetic materials
GUIDELINE STATEMETN 22
do not use hair-bearing skin
71
What technique should not be performed by a single-stage?
GUIDELINE STATEMENT 21
tubularized graft urethroplasty
due to high risk of restenosis
72
After pelvic fracture urethral injury (PFUI), planning a delayed repair, what testing should be done pre-operaitvely?
GUIDELINE STATEMENT 23
RUG + VCUG
and/or
Retrograde + Antegrade Cystoscopy
Other adjunctive tests include: pelvic CT or MRI to assess proximal extent of injury
73
After PFUI with urethral obstruction/obliteration due to pelvic fracture, what type of repair should be done? When?
GUIDELINE STATEMENT 24
delayed urethroplasty
GUIDELINE STATMENT 25
only after major injuries have stabilized and patients can be safely positioned
74
What are treatment options for bladder neck contracture after endoscopic prostate procedure?
GUIDELINE STATEMENT 26
Dilation
Bladder neck incision
transurethral resection of bladder neck contracture
75
What are treatment options for bladder neck contracture post prostatectomy for vesicourethral anastomotic strictures? What is performed for recalcitrant stenosis?
GUIDELINE STATEMENT 27
dilation
vesicourethral incision
transurethral resection
\*lower success in cases of radiation
GUIDELINE STATEMENT 28
open reconstruction of bladder neck
\*may need sphincter
76
Men who perform chronic CIC with strictures may be offered which treatment?
GUIDELINE STATMENT 29
urethroplasty
when causing problems with CIC
77
If alternative pathology is suspected in the urethra?
GUIDELINE STATEMENT 30
biopsy
for LS or suspected urethral cancer
78
Urethroplasty in a patient with LS, what is important to remember?
GUIDELINE STATEMENT 31
do not use genital skin
79
Follow up of urethral strictures?
GUIDELINE STATEMENT 32
monitor for symptomatic recurrence following dilation, DVIU, and urethroplasty
utilize AUA SS, uroflow, pvr
\*can occur at any time
\*risks for recurrence failed tx, tobacco, DM, increasing length, LS, hypo. graft/flap
80
AUA SS includes which elements, plus bother:
81
In the setting of a prior urethral stricture dilation, with pelvic trauma/fracture and blood at the meatus, what is the significance of a butterfly hematoma?
urethral injury
contained in Colles' facia
superiorly the extravasation can extend to clavicles where Scarpa's facies the abdominal extension of Colles' facia attaches
82
Describe endoscopic realignment in patient with urethral disruption for whom you have placed a SPT:
2 surgeons
flexible/rigid cystoscopy via urethra and SPT to try to pass a wire across the defect with fluoroscopy
prolonged attempts should not be performed
83
Describe posterior urethral stricture repair?
1. high lithotomy
2. lamba incision in perineum
3. divde bulbospongiosus muscle
4. circumferentially mobilize urethra distally to penoscrotal junction and proximally to obliterated segment of the urethra
5. excise intervening scar between distal urethral segment and apex of prostate
6. identify prostatic apex, if cannot reach → separate corpus cavernosum in midline, if cannot reach → perform pubectomy (give additional length), if still cannot reach → re-route urethra under ones side of corpus cavernosum
7. Tension free anastomosis
8. Foley
84
Etiologies of low Qmax and elevated PVR in a male?
NGB
BPH
urethral stricture
85
List risks of urethroplasty:
bleeding
infection
DVT
nerve damage (peroneal)
rectal injury
testicular injury
stricture recurrence
ED
EjD
urethrocutaneous fistula formation
penile chordee
altered penile sensation
post void dribbling
mouth scarring (buccal)
obstruction of salivary duct (buccal)
86
Describe a bulbar EPA urethroplasty:
1. vertical midline perineal incision
2. dissect through Colles' facia
3. divide bulbospongiosus muscle
4. circumferentially mobilize the urethral distally to penoscrotal junction and proximally towards membranous urethra after dividing central tenon
5. ID stricture by cysto
6. excise urethral stricture
7. spatulate proximal and distal ends of urethral 1 cm on each side
8. Distal spatulate ventrally
9. proximal spatulate dorsally
10. anastomosis with absorbable interrupted
11. foley
12. close
87
Describe substitution urethroplasty with buccal mucosa:
1. vertical midline perineal incision
2. dissect Colles' facia
3. sharply divide bulbospongiosus muscle
4. ID stricture via cysto
5. excise urethral stricture
6. spatulate urethra dorsally 1 cm on each side, measure defect
7. harvest buccal mucosa
8. fenestrate for dorsal, don't fenestrate for ventral
9. lay graft on corporal bodies an secure with absorbable suture
10. close lateral sides of buccal graft to native urethra with absorbable suture
11. test anastomosis for water tightness with irrigation in urethra
12. foley
13. close
88
What is blood supply to penis?
Internal iliac artery
Internal pudendal artery
Common penile artery
Bulbourethral artery → corpus spongiosum
Dorsal artery of penis → glans
Cavernosal artery → corpus cavernosa
Circumflex artery → crus of corpus cavernosa
89
What is blood supply to urethra?
dual blood supply
Proximal: bulbourethral artery → proximal corpus spongiosum
Distal: dorsal artery of penis → via communicators to glans penis
90
What questions do you ask a patient with suspect urethral stricture?
History of perineal/scrotal trauma
prior UTIs/STIs
Sexually active, ED, EjD
length of time of sxs
episodes of retention
hx of catheterization or difficulty with cath
hematuria
AUA SS
91
What is recurrence rate of DVIU at one year?
50% in 1 year
Follow with AUA SS, uroflow/pvr, cysto, RUG
92
At what diameter to strictures become symptomatic?
< 14 Fr
93
How does the location of the urethra differ between the penile and bulbar urethra?
The urethra is more dorsal in the spongiosum in the bulbar urethra and more central in the penile urethra.
94
What is the blood supply route to the deep penile structures?
Internal iliac --> Anterior division --> Internal pudendal --> Common Penile
95
What are the 4 branches of the common penile artery?
Bulbar artery
Urethral artery
Cavernosal artery
Deep dorsal artery
96
Recommend storage volume for orthotopic neobladder
400-500cc
97
Urinary continence mechanism for orthotopic neobladders
rhabdosphincter
98
Most definitive long term solution for uretero-enteric structures
surgical repair
must rule out malignancy
99
Options for first time bulbar urethral strictures <2 cm
Dilation
DVIU
100
Success rate of short bulbar strictures
50%
101
Operative recommendation for short bulbar strictures < 2 cm
excision and primary anastomosis.
Longer strictures or any penile strictures require graft or flap.
102
Stages of graft intake
1. first 48 hours: imbibition--> graft receives nutrients through diffusion.
2. Inosculation: Next 48 hours--> graft vessels connect with recipient bed vessels.
3. neovascularization 4-6 days`
103
Female urethral stricture
104
What is the normal caliber of the female urethra?
22F (18F - 28F 95% CI)
105
Name two types of flap urethroplasty techniques for female urethral reconstruction.
Blandy and Orandi techniques.
106
What are the main categories of voiding dysfunction?
Detrusor underactivity (DU) and bladder outflow obstruction (BOO).
107
What percentage of female urethral stricture cases are considered idiopathic?
44%-51% (Referenced from the etiology statistics)
108
What are the key symptoms associated with Female Urethral Stricture (FUS)?
Slow flow, incomplete bladder emptying, urine spraying, hesitancy, straining, dysuria, acute urinary retention, elevated residual urine, frequency, urinary incontinence, recurrent UTIs, hematuria, and urethral pain.
109
How is the buccal graft harvested for urethroplasty?
The graft is marked to the desired length, hydrodissected using lidocaine with epinephrine, incised at the edges, and then dissected free from underlying tissues.
110
What is the first documented report of Female Urethral Stricture (FUS)?
The first reported case of FUS was in 1828.
111
What are the main reported causes of FUS?
Iatrogenic injury, trauma, urinary tract infections (UTIs), inflammation, catheter-related inflammation, and surgeries like diverticulectomy, mesh removal, radiation, vaginal reconstruction, and female genital mutilation.
112
What is the importance of cystoscopy under anesthesia in diagnosing FUS?
Cystoscopy under anesthesia is valuable in instances of diagnostic uncertainty.
113
Describe the three stages of uroflowmetry results presented in the document for diagnosing urethral stricture.
Initial low flow with elevated PVR, return to bell-shaped curve post-dilation, and recurrence with plateau/mesa-shaped uroflow.
114
What are the recommended options for repeated endoscopic treatment of extensive or recurrent FUS?
Repeated endoscopic treatment is generally not recommended for extensive or recurrent strictures due to high recurrence rates.
115
Which graft is most commonly used in female urethral reconstruction?
Buccal mucosa is the majority of oral grafts used in female urethral reconstruction.
116
What is the recurrence-free rate at 12 months for women undergoing vaginal flap urethroplasty with either an advancement flap (Blandy) or tubularized flap (Orandi)?
77% of women were recurrence-free at 12 months.
117
What is the preferred catheter size and duration of catheterization postoperatively according to the document?
Nonlatex, 16Fr-18Fr urethral catheters for a duration of about 14 days.
118
What are the common surgical reconstruction options for Female Urethral Stricture (FUS)?
Options include urethral dilation, urethrotomy, urethroplasty (ventral, dorsal, combined), flap urethroplasty (Blandy, Orandi), and graft urethroplasty using buccal mucosa.
119
When is urethral dilation considered as a treatment for FUS?
Urethral dilation is used to stretch the lumen without worsening scarring, typically for less extensive strictures.
120
Describe the Blandy technique for flap urethroplasty.
The Blandy technique involves an inverted U incision in the anterior vaginal wall, flap development, incision, calibration, suturing, and closure.
121
What are the considerations for selecting the appropriate surgical approach for a urethral stricture?
Considerations include stricture characteristics (location, length, etiology), patient goals and preferences, surgeon expertise, and available techniques.
122
What are the challenges and recommendations specific to female urethrotomy?
Urethrotomy involves incision of the urethral scar tissue and can be performed with a cold knife, electrocautery, or laser. Challenges include the specificity of the female urethra and careful consideration of the type and location of the stricture.
123
When is graft urethroplasty using buccal mucosa considered for FUS?
Graft urethroplasty, predominantly using buccal mucosa, is considered in more complex cases of reconstruction and adapts methods used in male urethral reconstruction.
124
What are the potential complications of anterior vaginal flap urethroplasty (“Blandy”)?
Potential complications include spraying urinary stream and vaginal voiding.
125
What are the common symptoms of a Female Urethral Stricture (FUS)?
Symptoms can include slow flow, incomplete bladder emptying, urine spraying, hesitancy, straining, dysuria, acute urinary retention, elevated residual urine, frequency, urinary incontinence, recurrent UTIs, hematuria, and urethral pain.
126
What are the typical findings of overactive bladder?
Overactive bladder is characterized by symptoms of urinary urgency, frequency, and urgency incontinence, often without an obvious cause
127
What is a Skene's duct cyst, and what are its typical symptoms?
A Skene's duct cyst is a benign cyst located near the urethra, often asymptomatic but can cause dysuria or urinary frequency if large.
128
What is pseudo detrusor sphincter dyssynergia, and how is it diagnosed?
Pseudo detrusor sphincter dyssynergia is a condition where the urinary sphincter muscle does not relax properly during voiding. Diagnosis usually involves urodynamic testing, and symptoms may include difficulty urinating and high post-void residual volumes.
129
What is the significance of a normal uroflow with a maximum flow rate of 25 mL/s and a post-void residual of 30 mL?
A normal flow rate and low post-void residual indicate normal bladder emptying and are not typical for conditions that cause obstruction or significant retention.
130
What are the limitations of endoscopic dilation for treating Female Urethral Stricture (FUS)?
Endoscopic dilation has minimal risks but high recurrence rates, especially for extensive or recurrent strictures.
131
Describe the Blandy procedure (anterior vaginal mucosal flap urethroplasty) and its typical applications.
The Blandy technique involves an inverted U incision in the anterior vaginal wall, flap development, and closure. It's used for anterior vaginal flap urethroplasty but may have complications like spraying urinary stream and vaginal voiding.
132
What is a buccal graft dorsal urethroplasty, and when is it used?
Buccal graft dorsal urethroplasty involves using a graft from the mouth (buccal mucosa) placed on the dorsal side of the urethra. It's used for more complex reconstructions and can be considered when other methods have failed.
133
When is a buccal or vaginal graft ventral urethroplasty considered?
Buccal or vaginal graft ventral urethroplasty involves placing a graft on the ventral side of the urethra. It may be suitable when there's a lack of ventral urethral plate or when other methods like flap techniques have failed.
134
What are meatotomies, and why might they not be suitable for the given scenario?
Meatotomy involves an incision of the urethra at 6 o'clock rather than excision of the distal urethra. It may not be suitable for recurrent strictures following several procedures, as described in the question.
135
136
The male urethra is about___ cm long. The anterior urethra, which is surrounded by the ____, is approximately___ and lies within the penis distally and the perineum proximally. The anterior urethra can be further subdivided into the ____; the ___, which is surrounded by the ___ ; and the ___. The posterior urethra is ___ long and lies within the pelvis proximal to the ____. It can be further subdivided into the ___, __, and ___
The male urethra is about 18 to 20 cm long. The anterior urethra, which is surrounded by the corpus spongiosum, is approximately 16 cm and lies within the penis distally and the perineum proximally. The anterior urethra can be further subdivided into the pendulous or penile urethra; the bulbar urethra, which is surrounded by the bulbospongiosus muscle; and the fossa navicularis. The posterior urethra is 4 cm long and lies within the pelvis proximal to the corpus spongiosum. It can be further subdivided into the preprostatic or bladder neck, prostatic, and membranous urethra
137
The only absolute contraindication to urethral catheterization is a ___ or a history of ___
The only absolute contraindication to urethral catheterization is a suspected or confirmed urethral injury or a history of bladder neck closure or repair.
138
If BPH is suspected, ideally the clinician should use at least an ___
If BPH is suspected, ideally the clinician should use at least an 18-Fr catheter with a coudé tip.
139
Newborn males born with ___ may require urgent catheterization. A blunt-tip __ catheter can be placed in ice and then shaped with an anterior curve to allow the catheter to pass anterior to the valves.
Newborn males born with posterior urethral valves may require urgent catheterization. A blunt-tip 5-Fr catheter can be placed in ice and then shaped with an anterior curve to allow the catheter to pass anterior to the valves.
140
The clinician should obtain a thorough history and all prior operative records before instrumentation. If a ___ has been performed, obviously urethral catheterization should be avoided
The clinician should obtain a thorough history and all prior operative records before instrumentation. If a bladder neck closure has been performed, obviously urethral catheterization should be avoided
141
A 16-Fr catheter is approximately ____ cm in outer diameter.
a. 16
b. 10.4
c. 8.7
d. 5.3
d. 5.3. To calculate French size approximately, divide by 3
142
```
The most common cause of inability to catheterize an Indiana pouch
is _____.
a. perforation
b. catheter malfunction
c. overdistension
d. none of the above
```
Overdistension. Overdistension is the most common reason for
catheterization difficulty. If the catheter is forced, a perforation in
the channel will be likely. A 21-gauge needle can be placed into the
reservoir. After drainage, a catheter will usually pass without
difficulty
143
A urostomy should never be catheterized.
a. T
b. F
. b. F. Catheterizing a urostomy gently can be performed without
risk. Occasionally, catheterizing the stoma may be therapeutic in
cases such as stomal stenosis or parastomal hernia
144
Catheter-associated urinary tract infection is the most common type
of health care–associated infection
a. T
b. F
a. T. Unfortunately, this is true based on a Centers for Disease
Control and Prevention report. Decreasing catheter use should
decrease the hospital-acquired infection rates
145
```
The incidence of bladder cancer in spinal cord patients with chronic
catheters is _______.
a. 1%
b. 2%
c. 3%
d. 4%
e. 6%
```
a. 1%. There are retrospective studies that do show what appears to
be an increased risk of bladder cancer. Some recommend
surveillance after 8 years of chronic catheterization.
